| NPI | 1811519994 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TEQUILA GOLDEN Family Nurse Practictioner 407-766-8865 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family |
| Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Enumeration Date | 2020-05-12 |
| Last Update Date | 2023-07-20 |