| NPI | 1770902462 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY ANN CRUMLISH Pa, Owner 850-516-8737 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9102271) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP1866262) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: FL ARNP9102271) | |
| Enumeration Date | 2014-04-10 |
| Last Update Date | 2023-04-27 |