| NPI | 1629969027 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARSHA DONALDSON Vice President 904-376-3703 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207R00000X Internal Medicine | |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2025-07-14 |
| Last Update Date | 2025-07-14 |