| NPI | 1609512656 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ORLAND MATA CEO 863-840-0639 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RN0300X Internal Medicine, Nephrology |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 363LF0000X Nurse Practitioner, Family | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| 363LP2300X Nurse Practitioner, Primary Care | |
| Enumeration Date | 2022-05-11 |
| Last Update Date | 2025-06-18 |