| NPI | 1518780808 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTHONY MARK LAQUIDARA Psychiatric Nurse Practitioner/CEO 904-377-7903 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Enumeration Date | 2024-11-05 |
| Last Update Date | 2024-11-05 |