| NPI | 1790552875 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIE PETIOTE CEO 321-261-1058 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2023-12-07 |
| Last Update Date | 2024-01-29 |