Provider Demographics
NPI:1679044770
Name:REICHARDT, ABIGAIL (LM)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:REICHARDT
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2602 NW 6TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-2944
Mailing Address - Country:US
Mailing Address - Phone:352-377-3879
Mailing Address - Fax:352-478-0175
Practice Address - Street 1:2602 NW 6TH ST STE B
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-2944
Practice Address - Country:US
Practice Address - Phone:352-377-3879
Practice Address - Fax:352-478-0175
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL376176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMW376OtherMIDWIFERY LICENSE