| NPI | 1619210861 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARILENE GOPEZ LACSON Owner/Adminsitrator 386-503-9731 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP 9270072) |
| Additional Taxonomies | 363LX0001X Nurse Practitioner, Obstetrics & Gynecology (Licence: FL ARNP 9270072) |
| Enumeration Date | 2013-04-05 |
| Last Update Date | 2015-03-14 |