Gypsy Blue, LLC

Primary specialty

AcupuncturistTaxonomy code 171100000X

Legal business name

GYPSY BLUE, LLC

Doing business as

Gypsy Souls Natural Medicine

Practice address

4404 Groveland Ave
Sarasota, FL 34231-7556

Phone

(941) 726-7865

NPI assigned

Feb 10, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Yamaya Pino

Title

Owner

Phone

(941) 726-7865

Specialties & licenses 1

Addresses

Other names 1

• Gypsy Souls Natural Medicine Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1581292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581292800000",
    "number": "1093347809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 17963",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "342760963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4404 GROVELAND AVE",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "342317556",
            "telephone_number": "941-726-7865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GYPSY BLUE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-10",
        "last_updated": "2020-02-10",
        "certification_date": "2020-02-10",
        "status": "A",
        "authorized_official_last_name": "PINO",
        "authorized_official_first_name": "YAMAYA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "941-726-7865"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Acupuncturist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gypsy Souls Natural Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Luis Guillermo Guzman
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• Michelle Rene Gyger, LMT
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• Todd Russell Haag, CRNA
• Irene Haakman, CCC.SLP

• Acupuncturist in Sarasota, FL
• Providers in Sarasota, FL by specialty
• Acupuncturist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.