| NPI | 1811761240 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN CLUKIE Administrator 813-997-2099 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2023-11-07 |
| Last Update Date | 2024-08-20 |