| NPI | 1538557608 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LADAYSHA L JACKSON CEO 850-455-1252 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 163W00000X Registered Nurse |
| 208D00000X General Practice (Licence: FL ME57721) | |
| 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9361683) | |
| Enumeration Date | 2014-12-24 |
| Last Update Date | 2023-09-06 |