MEDICARE: GINA M WHITAKER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1699483784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA M WHITAKER

Provider Business Mailing Address
First Line	:	5004 PINETREE DR
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-7127
Country	:	US
Telephone Number	:	772-618-3318
Fax Number	:

Provider Business Practice Location Address
First Line	:	5004 PINETREE DR
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-7127
Country	:	US
Telephone Number	:	772-618-3318
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2022
Last Update Date	:	11/08/2022

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Directions to “ GINA M WHITAKER ” Practice Location

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