| NPI | 1558146738 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAQUITIA JONES Registered Agent/Owner 850-583-1723 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2023-08-28 |
| Last Update Date | 2023-09-24 |