| NPI | 1780382804 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELSEY WALLACE Director/Owner 813-629-0250 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2023-02-17 |
| Last Update Date | 2023-02-17 |