{
"Npi": {
"NPI": "1104182252",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BIRTH & WELLNESS CENTER OF GAINESVILLE, LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "815 STOCKTON ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "JACKSONVILLE",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32204-3521",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "904-990-3619",
"MailingAddressFaxNumber": "904-562-3402",
"FirstLinePracticeLocationAddress": "815 STOCKTON ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "JACKSONVILLE",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32204-3521",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "904-990-3619",
"PracticeLocationAddressFaxNumber": "904-562-3402",
"EnumerationDate": "04/03/2012",
"LastUpdateDate": "08/18/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CRICKMORE",
"AuthorizedOfficialFirstName": "SAMANTHA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER/MIDWIFE",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LM",
"AuthorizedOfficialTelephoneNumber": "352-278-4746",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QB0400X",
"TaxonomyName": "Birthing Clinic/Center",
"LicenseNumber": "335",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}