Healthcare Provider Details

I. General information

NPI: 1871420414
Provider Name (Legal Business Name): KRYSTAL BOGLE GREGG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 SW 9TH ST APT A
GAINESVILLE FL
32601-6478
US

IV. Provider business mailing address

715 SW 9TH ST APT A
GAINESVILLE FL
32601-6478
US

V. Phone/Fax

Practice location:
  • Phone: 352-316-6715
  • Fax:
Mailing address:
  • Phone: 352-316-6715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: