| NPI | 1861966186 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD J HANEL Owner 904-687-9486 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2019-01-21 |
| Last Update Date | 2020-04-01 |