| NPI | 1679881536 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARSHA DONALDSON Vice President 904-376-3703 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| 363L00000X Nurse Practitioner | |
| 208000000X Pediatrics | |
| Enumeration Date | 2010-09-14 |
| Last Update Date | 2025-10-10 |