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General NPI Number Information
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NPI Number | 1629750112
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Entity Type | Individual
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Provider Name | SAMANTHA GAYLE GWINN LMT, CNA
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Gender | Female
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Dates
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Enumeration Date | 08/03/2023
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Last Update Date | 08/03/2023
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Provider Practice Location Address
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Address Line | 1954 W STATE RD 426 SUITE 1124, STUDIO #13
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City | OVIEDO
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State | FL
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Zip | 32765
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Country | US
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Telephone | 386-675-8368
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Fax |
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Provider Business Mailing Address
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Address Line | 1366 E GARON CV
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City | GENEVA
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State | FL
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Zip | 32732-8818
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Country | US
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Telephone | 386-675-8368
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA90619
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License Number State | FL
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