Healthcare Provider Details

I. General information

NPI: 1568657476
Provider Name (Legal Business Name): ANITA CECILIA BYRD CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2007
Last Update Date: 09/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8075 GATE PKWY W #305
JACKSONVILLE FL
32216-3684
US

IV. Provider business mailing address

8075 GATE PKWY W #305
JACKSONVILLE FL
32216-3684
US

V. Phone/Fax

Practice location:
  • Phone: 904-296-2992
  • Fax: 904-296-2993
Mailing address:
  • Phone: 904-296-2992
  • Fax: 904-296-2993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number2663842
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: