Healthcare Provider Details

I. General information

NPI: 1477715472
Provider Name (Legal Business Name): UNIQUE LINGERIE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 04/15/2021
Certification Date: 08/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 SE 18TH AVE STE 200A
OCALA FL
34471-8228
US

IV. Provider business mailing address

5445 NE 1ST LN
OCALA FL
34470-3418
US

V. Phone/Fax

Practice location:
  • Phone: 352-877-8700
  • Fax: 352-608-9718
Mailing address:
  • Phone: 352-877-8700
  • Fax: 352-608-9718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224900000X
TaxonomyMastectomy Fitter
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: EDNA B. TURNER DEGENESTE
Title or Position: OWNER
Credential: CFM
Phone: 352-877-8700