| NPI | 1700262698 |
|---|---|
| Former Legal Business Name | BRICK CITY AESTHETICS LLC |
| Entity Type | Organization |
| Authorized Contact | CINDY ANN GROW Owner 352-267-8897 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL ARNP9326861) |
| Enumeration Date | 2015-08-03 |
| Last Update Date | 2015-09-28 |