| NPI | 1952134512 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEANINE CLARK Nurse Practitioner 239-443-8018 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 251E00000X Home Health |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2024-08-20 |
| Last Update Date | 2024-09-26 |