Healthcare Provider Details

I. General information

NPI: 1629624580
Provider Name (Legal Business Name): THE NEST OF LAKELAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2019
Last Update Date: 08/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3838 LAKELAND HILLS BLVD
LAKELAND FL
33805-1980
US

IV. Provider business mailing address

3838 LAKELAND HILLS BLVD
LAKELAND FL
33805-1980
US

V. Phone/Fax

Practice location:
  • Phone: 863-578-8633
  • Fax: 888-299-6337
Mailing address:
  • Phone: 863-578-8633
  • Fax: 888-299-6337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: MELISSA CONORD-MORROW
Title or Position: FOUNDER/DIRECTOR
Credential: LM, RN, IBCLC
Phone: 863-559-1991