| NPI | 1518793397 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY LE Billing Manager 352-604-9980 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine |
| 207R00000X Internal Medicine | |
| Enumeration Date | 2024-09-10 |
| Last Update Date | 2026-03-27 |