Healthcare Provider Details

I. General information

NPI: 1831347293
Provider Name (Legal Business Name): ALL WOMEN'S HEALTH CENTER OF GAINESVILLE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2008
Last Update Date: 08/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 NW 23RD AVE SUITE N
GAINESVILLE FL
32609-5415
US

IV. Provider business mailing address

2106 DREW ST STE 103
CLEARWATER FL
33765-3238
US

V. Phone/Fax

Practice location:
  • Phone: 352-378-9191
  • Fax: 352-372-4823
Mailing address:
  • Phone: 727-442-0445
  • Fax: 727-447-3797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number777
License Number StateFL

VIII. Authorized Official

Name: MARISELLA MARENGO
Title or Position: BILLING AND CONTRACT MANAGER
Credential:
Phone: 727-442-0445