NPI | 1598153652 |
---|---|
Entity Type | Organization |
Authorized Contact | DOUGLAS JAY TIDWELL Owner/President 941-726-2082 |
Organization Subpart ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9326689) |
Enumeration Date | 2014-12-24 |
Last Update Date | 2014-12-24 |