| Doctor Name: | GINA BIRMINGHAM |
| NPI Number: | 1295133999 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | CRC1329155 |
| Business Practice Address: | 525 West King Street St. Augustine, FL - 320841086 |
| Business Phone Number: | 9048240902 |
| Business Fax Number: | 9048249635 |
| Mailing Address: | Po Box 1086, ST AUGUSTINE |
| State: | FL |
| Postal Code: | 320851086 |
| Phone Number: | 9048240902 |
| Fax Number: | 9048249635 |
| NPI Enumeration Date: | 12/11/2014 |
| NPI Last Update Date: | 12/11/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 171WH0202X |
| License Number: | CRC1329155 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Contractor |
| Taxonomy Specialization: | Home Modifications |
| Taxonomy Definition: | |