Healthcare Provider Details

I. General information

NPI: 1770919573
Provider Name (Legal Business Name): SACRED BIRTH MIDWIFERY SERVICE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2013
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 BENMORE DR
WINTER PARK FL
32792-4101
US

IV. Provider business mailing address

422 RED COAT LN
ORLANDO FL
32825-3333
US

V. Phone/Fax

Practice location:
  • Phone: 407-469-5050
  • Fax: 407-942-2044
Mailing address:
  • Phone: 407-766-2857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW277
License Number StateFL

VIII. Authorized Official

Name: MICHELLE ISLA
Title or Position: OWNER/MIDWIFE
Credential: LM, CPM
Phone: 407-766-2857