Healthcare Provider Details

I. General information

NPI: 1952683260
Provider Name (Legal Business Name): GENTLE BIRTH OPTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2011
Last Update Date: 11/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

296 BAYSHORE DRIVE
NICEVILLE FL
32578
US

IV. Provider business mailing address

296 BAYSHORE DRIVE
NICEVILLE FL
32578
US

V. Phone/Fax

Practice location:
  • Phone: 850-279-6778
  • Fax: 850-254-1922
Mailing address:
  • Phone: 850-279-6778
  • Fax: 850-254-1922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License NumberBC-15960103
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA DENBOW
Title or Position: MANAGING MEMBER
Credential: CNM, ARNP
Phone: 850-279-6778