Healthcare Provider Details

I. General information

NPI: 1033895875
Provider Name (Legal Business Name): BEARTH SIDE MIDWIFERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 21ST AVE S
ST PETERSBURG FL
33705-2774
US

IV. Provider business mailing address

140 21ST AVE S
ST PETERSBURG FL
33705-2774
US

V. Phone/Fax

Practice location:
  • Phone: 727-316-0295
  • Fax: 727-342-6054
Mailing address:
  • Phone: 727-316-0295
  • Fax: 727-342-6054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ALIAJA ALLISON
Title or Position: MIDWIFE
Credential: LM, CPM
Phone: 727-316-0295