Basic Information
| Provider Information | |||||||||
| NPI: | 1003297532 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WINGATE | ||||||||
| FirstName: | JANICE | ||||||||
| MiddleName: | KENNARD | ||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2727 NW 43RD ST | ||||||||
| Address2: | SUITE B8 | ||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326066632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527457554 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2727 NW 43RD ST | ||||||||
| Address2: | SUITE B8 | ||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326066632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527457554 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2015 | ||||||||
| LastUpdateDate: | 06/10/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | MA73768 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.