Healthcare Provider Details

I. General information

NPI: 1205156296
Provider Name (Legal Business Name): A WOMAN'S PLACE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2010
Last Update Date: 10/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 NW 23RD AVE
CHIEFLAND FL
32626-1976
US

IV. Provider business mailing address

PO BOX 58
CHIEFLAND FL
32644-0058
US

V. Phone/Fax

Practice location:
  • Phone: 352-493-9393
  • Fax: 352-493-9390
Mailing address:
  • Phone: 352-493-9393
  • Fax: 352-493-9390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License NumberARNP9169564
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License NumberARNP9169564
License Number StateFL

VIII. Authorized Official

Name: LAUREN SUSAN WILLIAMS
Title or Position: ARNP/OWNER/PROVIDER
Credential: ARNP
Phone: 352-493-9393