Healthcare Provider Details

I. General information

NPI: 1760990055
Provider Name (Legal Business Name): BIRTH COLLECTIVE OF JACKSONVILLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2018
Last Update Date: 04/03/2019
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: 904-633-3333
  • Fax:
Mailing address:
  • Phone: 904-633-3333
  • 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 CINTRON
Title or Position: MIDWIFE/OWNER
Credential: LM, CNM
Phone: 904-633-3333