Healthcare Provider Details

I. General information

NPI: 1013873645
Provider Name (Legal Business Name): GENEVIEVE BANAAG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 12/29/2025
Certification Date: 12/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 S MAIN ST
GAINESVILLE FL
32601-6718
US

IV. Provider business mailing address

602 S MAIN ST
GAINESVILLE FL
32601-6718
US

V. Phone/Fax

Practice location:
  • Phone: 352-230-5910
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11042939
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: