| NPI | 1679878904 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD DEAN GLASSMAN Medical Director 904-652-0652 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 9193543) |
| Enumeration Date | 2011-01-18 |
| Last Update Date | 2011-01-18 |