| 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 |