| NPI | 1841611407 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IRA D LEE Owner 386-755-3300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL ARNP3091702) |
| Enumeration Date | 2013-12-30 |
| Last Update Date | 2013-12-30 |