| NPI | 1962060939 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEANETTE SMITH Credentialing Manager 352-634-8736 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2019-06-04 |
| Last Update Date | 2021-06-24 |