Healthcare Provider Details

I. General information

NPI: 1851485486
Provider Name (Legal Business Name): BRENDA GILMORE CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 10/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11175 COUNTY LINE RD
SPRING HILL FL
34609-5615
US

IV. Provider business mailing address

11175 COUNTY LINE RD
SPRING HILL FL
34609-5615
US

V. Phone/Fax

Practice location:
  • Phone: 352-686-8884
  • Fax: 352-684-6888
Mailing address:
  • Phone: 352-686-8884
  • Fax: 352-684-6888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number9305341
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: