Provider Demographics
NPI:1225251283
Name:ADKINS, DEETA WIDMER (AP, LMT)
Entity Type:Individual
Prefix:
First Name:DEETA
Middle Name:WIDMER
Last Name:ADKINS
Suffix:
Gender:F
Credentials:AP, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1771 SW 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-3427
Mailing Address - Country:US
Mailing Address - Phone:352-375-6626
Mailing Address - Fax:352-335-3939
Practice Address - Street 1:2411 NW 41ST ST
Practice Address - Street 2:SUITE D
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-7499
Practice Address - Country:US
Practice Address - Phone:352-375-0235
Practice Address - Fax:352-335-3939
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP665171100000X
FLMA8292225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC0243OtherACUPUNCTURE PROVIDER BCBS
FLC5562OtherMASSAGE PROVIDER BCBS
FLMA8292OtherMASSAGE STATE LICENSE
FLAP665OtherACUPUNCTURE LICENSE