| NPI | 1528868684 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARSHA V JACKSON Manager 954-204-7197 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| 363LG0600X Nurse Practitioner, Gerontology | |
| Enumeration Date | 2025-03-18 |
| Last Update Date | 2025-03-18 |