| NPI | 1982331211 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATRINA MERRITT Senior Manager, Credentialing 813-596-5726 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) |
| 207R00000X Internal Medicine | |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine | |
| Enumeration Date | 2022-08-05 |
| Last Update Date | 2024-01-15 |