| NPI | 1710654199 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH ELLYSON Chief Operations Officer 904-475-2039 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| 363A00000X Physician Assistant | |
| 363LA2200X Nurse Practitioner, Adult Health | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2021-08-24 |
| Last Update Date | 2021-08-24 |