Healthcare Provider Details

I. General information

NPI: 1295618536
Provider Name (Legal Business Name): GROW LAKELAND, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 S FLORIDA AVE
LAKELAND FL
33801-4619
US

IV. Provider business mailing address

1342 SUNNYDELL FARM LN
LAKELAND FL
33809-3001
US

V. Phone/Fax

Practice location:
  • Phone: 863-354-3332
  • Fax:
Mailing address:
  • Phone: 863-354-3332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE RENEA DAWSON
Title or Position: OWNER, LACTATION CONSULTANT
Credential: IBCLC
Phone: 863-354-3332