| NPI | 1730611278 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACIE LAWSON COO 813-549-2134 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2017-04-03 |
| Last Update Date | 2017-04-03 |