| NPI | 1518468966 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAREN JACKSON Owner 850-290-8410 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 363AM0700X Physician Assistant, Medical | |
| 363LA2200X Nurse Practitioner, Adult Health | |
| Enumeration Date | 2018-02-21 |
| Last Update Date | 2023-06-23 |