Provider Demographics
NPI:1679044770
Name:OWENS-REICHARDT, ABIGAIL (LM)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:OWENS-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 1:5310 NW 8TH AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4468
Mailing Address - Country:US
Mailing Address - Phone:352-377-3879
Mailing Address - Fax:352-478-0175
Practice Address - Street 1:5310 NW 8TH AVE STE 1
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4468
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:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL376176B00000X, 176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106771600Medicaid
FLMW376OtherMIDWIFERY LICENSE