Healthcare Provider Details

I. General information

NPI: 1578969200
Provider Name (Legal Business Name): HOLISTIC MATERNITY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2014
Last Update Date: 11/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10460 ROOSEVELT BLVD N SUITE 179
ST PETERSBURG FL
33716-3821
US

IV. Provider business mailing address

10460 ROOSEVELT BLVD N SUITE 179
ST PETERSBURG FL
33716-3821
US

V. Phone/Fax

Practice location:
  • Phone: 727-565-8798
  • Fax: 727-497-7913
Mailing address:
  • Phone: 727-565-8798
  • Fax: 727-497-7913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW268
License Number StateFL

VIII. Authorized Official

Name: KATRINA K HOLLON
Title or Position: OWNER/CEO
Credential: LM, CPM
Phone: 727-565-8798