Healthcare Provider Details

I. General information

NPI: 1205520384
Provider Name (Legal Business Name): NORTH FLORIDA MIDWIFERY & HOMEBIRTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2023
Last Update Date: 06/02/2023
Certification Date: 06/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 CHAFFEE POINT BLVD STE 11
JACKSONVILLE FL
32221-4131
US

IV. Provider business mailing address

PO BOX 207
PENNEY FARMS FL
32079-0207
US

V. Phone/Fax

Practice location:
  • Phone: 904-290-4114
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name: JESSICA LAKEY
Title or Position: OWNER
Credential: LM,CPM
Phone: 904-290-4114