Provider Demographics
NPI:1861646663
Name:GAINEY, STARR HANCOCK
Entity Type:Individual
Prefix:MRS
First Name:STARR
Middle Name:HANCOCK
Last Name:GAINEY
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 1:403 WALKER DR
Mailing Address - Street 2:
Mailing Address - City:INTERLACHEN
Mailing Address - State:FL
Mailing Address - Zip Code:32148-4370
Mailing Address - Country:US
Mailing Address - Phone:386-659-1622
Mailing Address - Fax:
Practice Address - Street 1:403 WALKER DR
Practice Address - Street 2:
Practice Address - City:INTERLACHEN
Practice Address - State:FL
Practice Address - Zip Code:32148-4370
Practice Address - Country:US
Practice Address - Phone:386-659-1622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLG500-788-56-510-0172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker