Healthcare Provider Details

I. General information

NPI: 1578001491
Provider Name (Legal Business Name): GENTLE JOURNEY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2017
Last Update Date: 02/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17505 N COUNTY ROAD 225
GAINESVILLE FL
32609-4431
US

IV. Provider business mailing address

17505 N COUNTY ROAD 225
GAINESVILLE FL
32609-4431
US

V. Phone/Fax

Practice location:
  • Phone: 228-623-6125
  • Fax: 352-485-1859
Mailing address:
  • Phone: 228-623-6125
  • Fax: 352-485-1859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW332
License Number StateFL

VIII. Authorized Official

Name: ANDREA REECE
Title or Position: OWNER
Credential: LM, CPM
Phone: 228-623-6125