| NPI | 1588345763 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE A LEWIS Owner 321-412-0577 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care |
| Enumeration Date | 2023-07-31 |
| Last Update Date | 2025-05-11 |