| NPI | 1770521460 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TONYA LYNN WHITE Provider Enrollment Director 954-377-2954 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2020-09-29 |