| NPI | 1699402131 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CREDENTIALING DEPT Credentialing Manager 813-284-4554 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 208000000X Pediatrics |
| 208D00000X General Practice | |
| Enumeration Date | 2022-08-04 |
| Last Update Date | 2024-07-16 |