Provider Demographics
NPI:1003297532
Name:WINGATE, JANICE KENNARD
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:KENNARD
Last Name:WINGATE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 NW 43RD ST
Mailing Address - Street 2:SUITE B8
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-6632
Mailing Address - Country:US
Mailing Address - Phone:352-745-7554
Mailing Address - Fax:
Practice Address - Street 1:2727 NW 43RD ST
Practice Address - Street 2:SUITE B8
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6632
Practice Address - Country:US
Practice Address - Phone:352-745-7554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-10
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA73768225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist