Provider Demographics
NPI:1841903614
Name:POE-STEWART, GINA
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:POE-STEWART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 PLACEDA ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32254-2527
Mailing Address - Country:US
Mailing Address - Phone:856-537-0723
Mailing Address - Fax:
Practice Address - Street 1:3131 PLACEDA ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32254-2527
Practice Address - Country:US
Practice Address - Phone:856-537-0723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-26
Last Update Date:2023-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist