| NPI | 1972319358 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY D. PROVOST Chief Operating Office 850-602-0625 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2024-12-10 |
| Last Update Date | 2024-12-10 |