| NPI | 1952056780 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERJUAN TOLES Practice Development Consultant 239-595-9040 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2022-02-21 |
| Last Update Date | 2022-03-26 |