| NPI | 1952828790 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICHOLAS J JACKSON Owner 561-307-7745 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 9294269) |
| Enumeration Date | 2017-08-23 |
| Last Update Date | 2017-08-23 |