Individual
GINA BIRMINGHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
525 WEST KING STREET, ST. AUGUSTINE, FL 32084-1086
(904) 824-0902
(904) 824-9635
Mailing address
PO BOX 1086, ST AUGUSTINE, FL 32085-1086
(904) 824-0902
(904) 824-9635
Taxonomy
Speciality
Code
Description
License number
State
171WH0202X
Home Modifications Contractor
Primary
CRC1329155
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006510900
—
FL
Enumeration date
12/11/2014
Last updated
12/11/2014
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