Healthcare Provider Details

I. General information

NPI: 1265820757
Provider Name (Legal Business Name): KIM FAUST CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2015
Last Update Date: 10/28/2023
Certification Date: 10/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CHILD ST DEPT 5000
JACKSONVILLE FL
32214-5000
US

IV. Provider business mailing address

2080 CHILD ST DEPT 5000
JACKSONVILLE FL
32214-5000
US

V. Phone/Fax

Practice location:
  • Phone: 904-542-7419
  • Fax:
Mailing address:
  • Phone: 904-542-7419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberAPRN9323452
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberARNP9323452
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: