Healthcare Provider Details

I. General information

NPI: 1053617696
Provider Name (Legal Business Name): TREE OF LIFE BIRTH AND GYNECOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2011
Last Update Date: 11/20/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 MONTGOMERY RD
ALTAMONTE SPRINGS FL
32714
US

IV. Provider business mailing address

165 MONTGOMERY RD
ALTAMONTE SPRINGS FL
32714
US

V. Phone/Fax

Practice location:
  • Phone: 407-878-2757
  • Fax: 407-288-8530
Mailing address:
  • Phone: 407-878-2757
  • Fax: 407-288-8530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number9170873
License Number StateFL

VIII. Authorized Official

Name: MS. KALEEN R RICHARDS
Title or Position: OWNER
Credential: ARNP, CNM
Phone: 407-929-6599