| NPI | 1831615087 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN CROKER Owner 386-473-3553 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL arnp3333802) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2017-08-19 |
| Last Update Date | 2020-08-12 |