Healthcare Provider Details

I. General information

NPI: 1487889424
Provider Name (Legal Business Name): DAFFINI HOPE TERRELL L.M., C.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2009
Last Update Date: 05/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1539 PARENTAL HOME RD
JACKSONVILLE FL
32216-3009
US

IV. Provider business mailing address

1539 PARENTAL HOME RD
JACKSONVILLE FL
32216-3009
US

V. Phone/Fax

Practice location:
  • Phone: 904-855-4211
  • Fax: 904-446-9083
Mailing address:
  • Phone: 904-855-4211
  • Fax: 904-446-9083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number210
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: