{
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"IsOrgSubpart": "N",
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"OrgName": "CLOVER LEAF MIDWIFERY, LLC",
"LastName": null,
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"NameSuffix": null,
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"FirstLineMailingAddress": "18865 STATE ROAD 54",
"SecondLineMailingAddress": "STE 181",
"MailingAddressCityName": "LUTZ",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33558-8201",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": "813-536-3061",
"FirstLinePracticeLocationAddress": "4020 BLUE LANTANA LN",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LAND O LAKES",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "34638-3561",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "727-387-3939",
"PracticeLocationAddressFaxNumber": "813-536-3061",
"EnumerationDate": "01/31/2023",
"LastUpdateDate": "01/31/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DIBARTOLO-BARCLAY",
"AuthorizedOfficialFirstName": "ERICA",
"AuthorizedOfficialMiddleName": "LEA",
"AuthorizedOfficialTitle": "MIDWIFE, OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LM, LMT",
"AuthorizedOfficialTelephoneNumber": "352-218-9288",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "176B00000X",
"TaxonomyName": "Midwife",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}