Provider Demographics
NPI:1104182252
Name:BIRTH & WELLNESS CENTER OF GAINESVILLE, LLC
Entity type:Organization
Organization Name:BIRTH & WELLNESS CENTER OF GAINESVILLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MIDWIFE
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRICKMORE
Authorized Official - Suffix:
Authorized Official - Credentials:LM
Authorized Official - Phone:352-278-4746
Mailing Address - Street 1:607 E UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-5449
Mailing Address - Country:US
Mailing Address - Phone:352-372-4784
Mailing Address - Fax:352-372-4788
Practice Address - Street 1:815 STOCKTON ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-3521
Practice Address - Country:US
Practice Address - Phone:904-990-3619
Practice Address - Fax:904-562-3402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-03
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL335261QB0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing