Healthcare Provider Details

I. General information

NPI: 1811234602
Provider Name (Legal Business Name): CELEBRATE BIRTH MIDWIFERY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2013
Last Update Date: 02/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 EDGEWATER BEACH DR
LAKELAND FL
33805-4737
US

IV. Provider business mailing address

1525 EDGEWATER BEACH DR
LAKELAND FL
33805-4737
US

V. Phone/Fax

Practice location:
  • Phone: 863-680-2229
  • Fax: 863-682-4784
Mailing address:
  • Phone: 863-680-2229
  • Fax: 863-682-4784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW175
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number268
License Number StateFL

VIII. Authorized Official

Name: JAMES ANDREW MORROW
Title or Position: VICE PRESIDENT
Credential:
Phone: 863-602-1422