Provider Demographics
NPI:1164944781
Name:MILLS, GINA SCHWARZ (ITDS)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:SCHWARZ
Last Name:MILLS
Suffix:
Gender:F
Credentials:ITDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5603 SUPERIOR DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-8006
Mailing Address - Country:US
Mailing Address - Phone:863-430-4714
Mailing Address - Fax:
Practice Address - Street 1:5603 SUPERIOR DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-8006
Practice Address - Country:US
Practice Address - Phone:863-430-4714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-14
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL222Q00000X
252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist