| NPI | 1861220626 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICHOLAS J BRANTLEY Provider/Owner 727-804-8193 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2024-07-23 |
| Last Update Date | 2025-01-29 |