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General NPI Number Information
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NPI Number | 1558944546
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Entity Type | Organization
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Legal Business Name | THE BIRTH TRIBE LLC
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Dates
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Enumeration Date | 04/28/2021
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Last Update Date | 04/28/2021
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Provider Practice Location Address
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Address Line | 800 S NOVA RD STE R
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City | ORMOND BEACH
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State | FL
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Zip | 32174-7362
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Country | US
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Telephone | 386-227-7663
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Fax | 386-204-7117
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Provider Business Mailing Address
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Address Line | 17 PINE GROVE DR SIDE A
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City | PALM COAST
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State | FL
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Zip | 32164-7098
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Country | US
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Telephone | 914-299-7171
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Fax | 386-204-7117
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Authorized Official
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Title or Position | MIDWIFE/OWNER
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Name | SERENA BURR
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Credential | LM
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Telephone | 914-299-7171
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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 |
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License Number State |
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