| NPI | 1811741796 |
|---|---|
| Former Legal Business Name | N/A |
| Entity Type | Organization |
| Authorized Contact | GARDINE JACQUES Owner 305-519-7951 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2024-04-16 |
| Last Update Date | 2024-04-22 |