| NPI | 1619790334 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PRADEEP JOHN Manager 813-252-1124 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 261Q00000X Clinic/Center | |
| Enumeration Date | 2024-11-01 |
| Last Update Date | 2026-03-20 |