| NPI | 1760840938 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FELICIA ANN JENKINS Owner/Provider 352-630-3056 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2016-02-03 |
| Last Update Date | 2016-02-03 |