Healthcare Provider Details

I. General information

NPI: 1922912278
Provider Name (Legal Business Name): DIFFERENT STORKS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11990 BEACH BLVD APT 353
JACKSONVILLE FL
32246-8435
US

IV. Provider business mailing address

11990 BEACH BLVD APT 353
JACKSONVILLE FL
32246-8435
US

V. Phone/Fax

Practice location:
  • Phone: 703-517-5584
  • Fax:
Mailing address:
  • Phone: 703-517-5584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. LAUREN TYLER SMITH
Title or Position: DOULA
Credential: CLD, CPD
Phone: 703-517-5584