Healthcare Provider Details

I. General information

NPI: 1720236383
Provider Name (Legal Business Name): ANCIENT CITY MIDWIVES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2008
Last Update Date: 05/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PLANTATION ISLAND DR S STE 105-B
ST AUGUSTINE FL
32080-3108
US

IV. Provider business mailing address

PO BOX 3123
ST AUGUSTINE FL
32085-3123
US

V. Phone/Fax

Practice location:
  • Phone: 904-826-1007
  • Fax: 904-826-1073
Mailing address:
  • Phone: 904-824-4990
  • Fax: 904-824-2226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberARNP 1634442
License Number StateFL

VIII. Authorized Official

Name: MICHELE ROGERO
Title or Position: PRESIDENT
Credential: ARNP CNM
Phone: 904-826-1007