Healthcare Provider Details

I. General information

NPI: 1336123579
Provider Name (Legal Business Name): JANE M BRIGHAM CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANE M BERRY CNM

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 05/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 TAMPA GENERAL CIR 6STC
TAMPA FL
33606-3603
US

IV. Provider business mailing address

2 TAMPA GENERAL CIR 6STC
TAMPA FL
33606-3603
US

V. Phone/Fax

Practice location:
  • Phone: 810-656-4006
  • Fax:
Mailing address:
  • Phone: 810-656-4006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number4704206781
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number9399322
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: