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NPI 1023654654 · on the registry since 2019 · sole proprietor
Practice
- Address
- 1845 Holsonback Dr.
Daytona Beach, FL 32117 - Phone
- (386) 274-0500
- Organisation at this address
- Florida Department Of Health
Inferred from a shared address, not stated in the registry.
- Clinicians at this address
- 50
Additional practice sites
- 301 Dr Carter Blvd, Bunnell, FL
Registry record
- Primary taxonomy
- 363LF0000X
363LF0000X
- Licence states on file
- FL
From the registry's licence fields, which are often incomplete.
- Sex
- Female
- Record last updated
- 2025-06-17
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Florida