Provider Demographics
NPI:1700355732
Name:VREELAND, MIMI CAROLINE
Entity Type:Individual
Prefix:
First Name:MIMI
Middle Name:CAROLINE
Last Name:VREELAND
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 1:13 EUGENE PL
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-5338
Mailing Address - Country:US
Mailing Address - Phone:904-814-4323
Mailing Address - Fax:
Practice Address - Street 1:2225 A1A S STE B2
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-2919
Practice Address - Country:US
Practice Address - Phone:904-814-4323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2950171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist