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 |