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General NPI Number Information
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NPI Number | 1154500056
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Entity Type | Individual
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Provider Name | MATTIE GALLAGHER DUCOIN CNM
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Gender | Female
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Dates
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Enumeration Date | 10/26/2007
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Last Update Date | 10/26/2020
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Provider Practice Location Address
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Address Line | 2 TAMPA GENERAL CIR
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City | TAMPA
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State | FL
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Zip | 33606
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Country | US
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Telephone | 813-974-2201
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 917770
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City | ORLANDO
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State | FL
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Zip | 32891-0001
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Country | US
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Telephone | 813-974-2201
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | MW206
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | AP08269
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | 0024170143
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | APRN9369604
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License Number State | FL
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