| NPI | 1801499371 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEMETRIS WEAVER President 813-252-6114 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 207P00000X Emergency Medicine |
| 261Q00000X Clinic/Center | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2020-11-18 |
| Last Update Date | 2023-08-11 |