Healthcare Provider Details

I. General information

NPI: 1770910721
Provider Name (Legal Business Name): MIDWIVES COOPERATIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2013
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5310 NW 8TH AVE STE 1
GAINESVILLE FL
32605-4468
US

IV. Provider business mailing address

5310 NW 8TH AVE STE 1
GAINESVILLE FL
32605-4468
US

V. Phone/Fax

Practice location:
  • Phone: 352-377-3879
  • Fax: 386-462-9021
Mailing address:
  • Phone: 352-377-3879
  • Fax: 352-478-0175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name: ABIGAIL OWENS-REICHARDT
Title or Position: OWNER, LICENSED MIDWIFE
Credential: LM
Phone: 352-377-3879