| NPI | 1821372129 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDA ROSEQUIST Practice Administrator 813-948-3838 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL 0048283) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL 0040424) |
| Enumeration Date | 2011-10-05 |
| Last Update Date | 2011-10-05 |