Healthcare Provider Details

I. General information

NPI: 1104182252
Provider Name (Legal Business Name): BIRTH & WELLNESS CENTER OF GAINESVILLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2012
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 STOCKTON ST
JACKSONVILLE FL
32204-3521
US

IV. Provider business mailing address

815 STOCKTON ST
JACKSONVILLE FL
32204-3521
US

V. Phone/Fax

Practice location:
  • Phone: 904-990-3619
  • Fax: 904-562-3402
Mailing address:
  • Phone: 904-990-3619
  • Fax: 904-562-3402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number335
License Number StateFL

VIII. Authorized Official

Name: SAMANTHA CRICKMORE
Title or Position: OWNER/MIDWIFE
Credential: LM
Phone: 352-278-4746