Healthcare Provider Details

I. General information

NPI: 1710784301
Provider Name (Legal Business Name): LACTATION LADIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2025
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRED WILLIAMS RD
PERRY FL
32347-1127
US

IV. Provider business mailing address

75 FRED WILLIAMS RD
PERRY FL
32347-1127
US

V. Phone/Fax

Practice location:
  • Phone: 386-281-7685
  • Fax: 386-382-4003
Mailing address:
  • Phone: 386-281-7685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY SHIVER
Title or Position: FOUNDER
Credential:
Phone: 386-281-7685