Healthcare Provider Details

I. General information

NPI: 1124760376
Provider Name (Legal Business Name): SUNSHINE LACTATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2022
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 3RD ST S STE 206
JACKSONVILLE BEACH FL
32250-6685
US

IV. Provider business mailing address

830 3RD ST S STE 206
JACKSONVILLE BEACH FL
32250-6685
US

V. Phone/Fax

Practice location:
  • Phone: 904-323-1418
  • Fax:
Mailing address:
  • Phone: 904-323-1418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name: JESSICA KYRA PHILLIPS
Title or Position: IBCLC
Credential: IBCLC
Phone: 904-323-1418