NPI | 1740479096 |
---|---|
Entity Type | Organization |
Authorized Contact | MARLO LUCIANI Office Manager 321-453-1955 |
Organization Subpart ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL os7484) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL os9648) |
363L00000X Nurse Practitioner (Licence: FL ARNP1657502) | |
Enumeration Date | 2007-10-22 |
Last Update Date | 2022-05-04 |