| NPI | 1831954387 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DA'TWAN LAURICE MATHIS Owner 813-420-7361 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2024-02-14 |
| Last Update Date | 2024-02-14 |