Healthcare Provider Details

I. General information

NPI: 1952216186
Provider Name (Legal Business Name): LAKELAND BIRTH AND GYNECOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 E EDGEWOOD DR STE 9
LAKELAND FL
33803-3634
US

IV. Provider business mailing address

4208 OLLIE RD
LAKELAND FL
33810-0122
US

V. Phone/Fax

Practice location:
  • Phone: 863-666-7555
  • Fax: 726-239-5636
Mailing address:
  • Phone: 863-666-7555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY N PAYNE
Title or Position: OWNER
Credential: APRN, CNM
Phone: 863-666-7555