| NPI | 1710509203 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELIZABETH TIBBS Vice President 904-202-3283 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| 207R00000X Internal Medicine | |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2020-05-07 |
| Last Update Date | 2026-04-27 |