Healthcare Provider Details

I. General information

NPI: 1255453205
Provider Name (Legal Business Name): JOHANNA P DELONGAIG CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 04/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 ARLINGTON ST SUITE 203
SARASOTA FL
34239-3507
US

IV. Provider business mailing address

1950 ARLINGTON ST SUITE 203
SARASOTA FL
34239-3507
US

V. Phone/Fax

Practice location:
  • Phone: 941-379-6331
  • Fax: 941-379-5642
Mailing address:
  • Phone: 941-379-6331
  • Fax: 941-379-5642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number9430582
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: