| NPI | 1568096790 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURIE HERNANDEZ Credentialing Specialist 727-800-2332 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2020-02-26 |
| Last Update Date | 2020-05-18 |