| NPI | 1639827033 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CORY WORTHINGTON LUCAS Nurse Practitioner 941-777-5665 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2022-03-15 |
| Last Update Date | 2026-03-11 |