Healthcare Provider Details

I. General information

NPI: 1205668282
Provider Name (Legal Business Name): DOMINIQUE CRIBB BIRTH DOULA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2024
Last Update Date: 08/17/2024
Certification Date: 08/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 JEFFERSON CLIFFS WAY APT 223
ARLINGTON TX
76006-6902
US

IV. Provider business mailing address

8802 FROSTWOOD CT S
TAMPA FL
33634
US

V. Phone/Fax

Practice location:
  • Phone: 813-789-8515
  • Fax:
Mailing address:
  • Phone: 813-789-8515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: