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: |