| NPI | 1780367391 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FANISKA MASSILLON Administrator 407-308-9573 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family |
| Additional Taxonomies | 163W00000X Registered Nurse |
| Enumeration Date | 2023-08-09 |
| Last Update Date | 2023-08-09 |