| NPI | 1619643608 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA V HENDERSON Medical Staff Coordinator 727-455-1992 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2021-08-19 |
| Last Update Date | 2026-01-22 |