| NPI | 1942313879 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NANCY T BOURG CEO 561-889-1227 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2020-09-22 |