Healthcare Provider Details

I. General information

NPI: 1578975579
Provider Name (Legal Business Name): ANIELA GWINN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANIELA KAMIENSKI

II. Dates (important events)

Enumeration Date: 05/24/2014
Last Update Date: 03/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 N JEFFERSON ST
JACKSONVILLE FL
32209-6810
US

IV. Provider business mailing address

7500 DEVONDALE WAY
JACKSONVILLE FL
32256-4831
US

V. Phone/Fax

Practice location:
  • Phone: 913-449-1927
  • Fax:
Mailing address:
  • Phone: 913-449-1927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: