Healthcare Provider Details

I. General information

NPI: 1831437201
Provider Name (Legal Business Name): SWEET CHILD O MINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2013
Last Update Date: 01/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 LITHIA PINECREST RD
BRANDON FL
33511-5307
US

IV. Provider business mailing address

215 LITHIA PINECREST RD
BRANDON FL
33511-5307
US

V. Phone/Fax

Practice location:
  • Phone: 813-685-8404
  • Fax: 813-298-0620
Mailing address:
  • Phone: 813-685-8404
  • Fax: 813-298-0620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY A VERBARG
Title or Position: ADMINISTRATOR
Credential: L.M.
Phone: 813-685-8404