| NPI | 1619776374 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY ANN DAMIELA THOMPSON Co Owner 954-671-0258 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2025-03-13 |
| Last Update Date | 2025-06-20 |