| NPI | 1952095747 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSH HAARIS Credentialing Manager 321-320-7512 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2023-06-06 |
| Last Update Date | 2023-06-23 |