Healthcare Provider Details

I. General information

NPI: 1326802240
Provider Name (Legal Business Name): JULIE BAUMGARTNER IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2024
Last Update Date: 02/09/2025
Certification Date: 02/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 KING ST UNIT 312
ST AUGUSTINE FL
32085-7713
US

IV. Provider business mailing address

99 KING ST UNIT 312
ST AUGUSTINE FL
32085-7713
US

V. Phone/Fax

Practice location:
  • Phone: 727-992-3843
  • Fax:
Mailing address:
  • Phone: 727-992-3843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-314544
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: