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 |