Basic Information
| Provider Information | |||||||||
| NPI: | 1083832737 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ARSENAULT | ||||||||
| FirstName: | GINA | ||||||||
| MiddleName: | RAE | ||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | KINCAID | ||||||||
| OtherFirstName: | GINA | ||||||||
| OtherMiddleName: | RAE | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 13060 39TH PL | ||||||||
| Address2: | |||||||||
| City: | WELLBORN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320942164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3869631516 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1601 SW ARCHER RD | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326081135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523761611 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 3390042 | FL | Y | Nursing Service Providers | Registered Nurse |
No ID Information.