=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841898301
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CONCIERGE WOMEN'S CARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/15/2020
-----------------------------------------------------
Last Update Date | 10/15/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10107 AUTHORS WAY
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32832-6349
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-974-7171
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10524 MOSS PARK RD STE 204-603
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32832-5898
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-974-7171
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CNM/CO-OWNER
-----------------------------------------------------
Name | TRACY COWART
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 407-974-7171
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367A00000X
-----------------------------------------------------
Taxonomy Name | Advanced Practice Midwife
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------