| NPI | 1891558649 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VANISE BASTIEN Ap RN 321-368-4868 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2024-02-05 |
| Last Update Date | 2024-02-05 |