| NPI | 1861263147 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE J VEGA Director Of Clinical Services 386-775-3840 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Enumeration Date | 2024-01-15 |
| Last Update Date | 2025-08-05 |