Healthcare Provider Details

I. General information

NPI: 1225860661
Provider Name (Legal Business Name): STA BIRTH COLLECTIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2024
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5A SANCHEZ AVE
ST AUGUSTINE FL
32084-3284
US

IV. Provider business mailing address

1140 HYACINTH ST
ST AUGUSTINE FL
32092-2432
US

V. Phone/Fax

Practice location:
  • Phone: 904-900-0900
  • Fax:
Mailing address:
  • Phone: 904-900-0900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TIFFANY MARTIN
Title or Position: OWNER/MIDWIFE
Credential: LM, CPM
Phone: 904-900-0900