Doctor Name: | MRS. GINA REBECCA MIDYETT |
NPI Number: | 1083896021 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA |
License Number: | IMH5698 |
Business Practice Address: | 16106 Darnell Rd Lutz, FL - 335493701 |
Business Phone Number: | 8134549656 |
Business Fax Number: | |
Mailing Address: | 16106 Darnell Rd, LUTZ |
State: | FL |
Postal Code: | 335493701 |
Phone Number: | 8134549656 |
Fax Number: | |
NPI Enumeration Date: | 11/30/2007 |
NPI Last Update Date: | 11/30/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | IMH5698 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |