| NPI | 1760991988 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK ALEXANDER FONSECA Cco 786-493-6556 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL ARNP9309582) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: FL ARNP9309582) |
| Enumeration Date | 2017-09-20 |
| Last Update Date | 2022-07-21 |