Healthcare Provider Details

I. General information

NPI: 1093945115
Provider Name (Legal Business Name): LYDIA B APOLLO CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2009
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1061 MEDICAL CENTER DR
ORANGE CITY FL
32763-8200
US

IV. Provider business mailing address

2363 7 LKS S
WEST END NC
27376-9601
US

V. Phone/Fax

Practice location:
  • Phone: 386-917-5000
  • Fax:
Mailing address:
  • Phone: 910-322-3589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number13054
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number441
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: