| NPI | 1992735682 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMY VANTASSELL Office Mngr 352-527-2287 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME0048978) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL PT5465) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2020-08-22 |