Healthcare Provider Details

I. General information

NPI: 1831758960
Provider Name (Legal Business Name): EDWIN URIBE AP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 07/08/2021
Certification Date: 07/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2610 NW 43RD ST STE 1B
GAINESVILLE FL
32606-6677
US

IV. Provider business mailing address

2011 NW 22ND ST
GAINESVILLE FL
32605-3947
US

V. Phone/Fax

Practice location:
  • Phone: 352-448-5836
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP3675
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: