| NPI | 1780575183 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEEANN MENGEL Vice President 904-202-7300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208800000X Urology |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363L00000X Nurse Practitioner | |
| 208600000X Surgery | |
| 2086X0206X Surgery, Surgical Oncology | |
| Enumeration Date | 2025-07-14 |
| Last Update Date | 2025-07-14 |