| NPI | 1710211289 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS L GASKIN CFO 386-274-4750 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9211084) |
| Enumeration Date | 2009-09-30 |
| Last Update Date | 2009-11-04 |