| NPI | 1902295512 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHANDA LYNN MOORE CEO 904-759-5089 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LC1500X Nurse Practitioner, Community Health (Licence: FL arnp9300116) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL mh8370) |
| Enumeration Date | 2015-01-20 |
| Last Update Date | 2015-01-20 |