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General NPI Number Information
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NPI Number | 1174284038
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Entity Type | Organization
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Legal Business Name | LIFE TREE WOMEN CARE, INC.
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Dates
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Enumeration Date | 01/04/2022
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Last Update Date | 10/02/2023
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Provider Practice Location Address
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Address Line | 5500 BLANDING BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32244-1946
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Country | US
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Telephone | 904-379-2540
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Fax | 904-379-2541
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Provider Business Mailing Address
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Address Line | 5500 BLANDING BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32244-1946
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Country | US
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Telephone | 904-379-2540
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Fax | 904-379-2541
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Authorized Official
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Title or Position | OWNER, MEDICAL PROVIDER
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Name | JAMIE NEAL
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Credential | APRN, CNM
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Telephone | 904-379-2540
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WW0101X
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Taxonomy Name | Ambulatory Women's Health Care Registered Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QB0400X
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Taxonomy Name | Birthing Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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