| NPI | 1720835101 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE LEA ANTANOVICH Owner 941-310-1863 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Enumeration Date | 2024-05-02 |
| Last Update Date | 2024-05-02 |