| NPI | 1679981641 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRISTA CORBETT Physician Assistant 239-333-4100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9106885) |
| Enumeration Date | 2014-07-23 |
| Last Update Date | 2016-04-01 |