| NPI | 1568809358 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY G. GANTT President 813-281-0300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery |
| Additional Taxonomies | 2086S0120X Surgery Pediatric Surgery |
| 363LF0000X Nurse Practitioner Family | |
| 363LP0200X Nurse Practitioner Pediatrics | |
| Enumeration Date | 2013-06-03 |
| Last Update Date | 2024-01-08 |