Healthcare Provider Details

I. General information

NPI: 1174284038
Provider Name (Legal Business Name): LIFE TREE WOMEN CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2022
Last Update Date: 10/02/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 BLANDING BLVD
JACKSONVILLE FL
32244-1946
US

IV. Provider business mailing address

5500 BLANDING BLVD
JACKSONVILLE FL
32244-1946
US

V. Phone/Fax

Practice location:
  • Phone: 904-379-2540
  • Fax: 904-379-2541
Mailing address:
  • Phone: 904-379-2540
  • Fax: 904-379-2541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JAMIE NEAL
Title or Position: OWNER, MEDICAL PROVIDER
Credential: APRN, CNM
Phone: 904-379-2540