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General NPI Number Information
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NPI Number | 1780074401
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Entity Type | Organization
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Legal Business Name | SAMANTHA CRICKMORE
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Dates
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Enumeration Date | 02/02/2015
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Last Update Date | 02/02/2015
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Provider Practice Location Address
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Address Line | 721 FOXBRIAR CV
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City | JACKSONVILLE
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State | FL
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Zip | 32221-1508
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Country | US
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Telephone | 352-278-4746
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Fax |
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Provider Business Mailing Address
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Address Line | 721 FOXBRIAR CV
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City | JACKSONVILLE
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State | FL
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Zip | 32221-1508
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Country | US
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Telephone | 352-278-4746
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Fax |
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Authorized Official
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Title or Position | LICENSED MIDWIFE
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Name | MRS. SAMANTHA BROOKE CRICKMORE
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Credential | L.M., C.P.M.
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Telephone | 352-278-4746
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QB0400X
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Taxonomy Name | Birthing Clinic/Center
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License Number | MW306
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License Number State | FL
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