| NPI | 1609378991 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY T RANDOLPH Owner/Manager 813-846-7698 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL ARNP9318390) |
| 261QH0100X Clinic/Center, Health Services | |
| Enumeration Date | 2018-03-02 |
| Last Update Date | 2021-05-12 |