| NPI | 1902593809 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYRONE MEDINA Md 239-649-3333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2023-04-20 |
| Last Update Date | 2025-05-01 |