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General NPI Number Information
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NPI Number | 1730579699
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Entity Type | Organization
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Legal Business Name | WILLOUGHBY MIDWIFERY LLC
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Dates
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Enumeration Date | 01/30/2015
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Last Update Date | 01/30/2015
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Provider Practice Location Address
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Address Line | 1405 DR MLK JR ST N
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City | SAINT PETERSBURG
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State | FL
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Zip | 33704
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Country | US
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Telephone | 727-895-2300
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Fax | 727-895-2375
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Provider Business Mailing Address
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Address Line | 1405 DR MLK JR ST N
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City | SAINT PETERSBURG
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State | FL
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Zip | 33704
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Country | US
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Telephone | 727-895-2300
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Fax | 727-895-2375
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Authorized Official
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Title or Position | OWNER
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Name | JESSICA DARLENE WILLOUGHBY
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Credential |
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Telephone | 727-895-2300
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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 | MW289
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License Number State | FL
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