| NPI | 1780655373 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHIRLEY LOUISE RUSSELL Np 904-542-7500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024000076) |
| Enumeration Date | 2006-01-31 |
| Last Update Date | 2008-08-13 |