Provider Demographics
NPI:1962533471
Name:ENGLERT, GINA (LMT)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:ENGLERT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 84
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32669-0084
Mailing Address - Country:US
Mailing Address - Phone:352-870-2223
Mailing Address - Fax:
Practice Address - Street 1:2731 NW 41ST ST
Practice Address - Street 2:B-2
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-7467
Practice Address - Country:US
Practice Address - Phone:352-870-2223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL37082174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist