| NPI | 1649813536 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELINE USTACHE Owner 813-820-2909 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Enumeration Date | 2019-10-23 |
| Last Update Date | 2019-10-23 |