Healthcare Provider Details

I. General information

NPI: 1528539632
Provider Name (Legal Business Name): TEN MOONS MIDWIFERY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 12/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

684 TIMBERMILL LN
ORANGE PARK FL
32065-2231
US

IV. Provider business mailing address

684 TIMBERMILL LN
ORANGE PARK FL
32065-2231
US

V. Phone/Fax

Practice location:
  • Phone: 904-589-7290
  • Fax:
Mailing address:
  • Phone: 904-589-7290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name: SHEA D CINTRON
Title or Position: MIDWIFE
Credential: LM, CPM
Phone: 904-589-7290