| NPI | 1811177264 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JORGE CICCONE Owner 954-941-1399 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL hcc5957) |
| Enumeration Date | 2007-11-13 |
| Last Update Date | 2007-11-13 |