| NPI | 1861376774 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MANUEL FONSECA Owner 352-215-1501 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 207R00000X Internal Medicine | |
| 207RC0000X Internal Medicine, Cardiovascular Disease | |
| 261Q00000X Clinic/Center | |
| 261QP2000X Clinic/Center, Physical Therapy | |
| Enumeration Date | 2025-08-04 |
| Last Update Date | 2025-09-12 |