| NPI | 1962367219 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLI NICOLE BRIDGMAN Nurse Practitioner 386-308-5088 |
| Organization Subpart ? | No |
| Primary Taxonomy | 202D00000X Integrative Medicine |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2025-12-18 |
| Last Update Date | 2026-06-04 |