Healthcare Provider Details

I. General information

NPI: 1174805808
Provider Name (Legal Business Name): GROWING FAMILIES MIDWIFERY SERVICE AND BIRTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2011
Last Update Date: 06/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 US 1 S SUITE A
ST AUGUSTINE FL
32086-7150
US

IV. Provider business mailing address

3750 US 1 S SUITE A
ST AUGUSTINE FL
32086-7150
US

V. Phone/Fax

Practice location:
  • Phone: 904-460-2771
  • Fax: 904-460-2711
Mailing address:
  • Phone: 904-460-2771
  • Fax: 904-460-2711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number338
License Number StateFL

VIII. Authorized Official

Name: MRS. MISTI BALZER
Title or Position: OWNER/DIRECTOR/MIDWIFE
Credential: LM, CPM
Phone: 904-460-2771