Healthcare Provider Details

I. General information

NPI: 1033629043
Provider Name (Legal Business Name): JAMIE NOAH STUBBS I LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2017
Last Update Date: 06/19/2020
Certification Date: 06/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4041 NW 37TH PL STE A
GAINESVILLE FL
32606-6112
US

IV. Provider business mailing address

4820 W NEWBERRY RD
GAINESVILLE FL
32607-2249
US

V. Phone/Fax

Practice location:
  • Phone: 352-328-5642
  • Fax: 352-225-3251
Mailing address:
  • Phone: 352-373-2116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA87798
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: