| NPI | 1811203953 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CASSANDRA HICKS Owner/Manager 772-216-6750 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9275760) |
| Enumeration Date | 2010-08-26 |
| Last Update Date | 2015-04-08 |