| NPI | 1700109915 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHNNIE R DEGRAW Owner 352-794-3872 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA2646) |
| 363LA2200X Nurse Practitioner, Adult Health | |
| Enumeration Date | 2010-03-03 |
| Last Update Date | 2020-10-01 |