Healthcare Provider Details

I. General information

NPI: 1689431025
Provider Name (Legal Business Name): CROWNING MIDWIFERY, BIRTH SERVICES, AND BEYOND PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 03/04/2024
Certification Date: 03/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14050 INTEGRA DR APT 1112
JACKSONVILLE FL
32218-2669
US

IV. Provider business mailing address

6501 ARLINGTON EXPY B105 #7003
JACKSONVILLE FL
32211
US

V. Phone/Fax

Practice location:
  • Phone: 850-296-7608
  • Fax: 850-204-7718
Mailing address:
  • Phone: 305-510-9654
  • Fax: 850-204-7718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLEY HOMER
Title or Position: MIDWIFE/OWNER
Credential:
Phone: 305-510-9654