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General NPI Number Information
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NPI Number | 1942085410
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Entity Type | Organization
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Legal Business Name | OPTIMOM LACTATION SERVICES, LLC.
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Dates
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Enumeration Date | 08/31/2023
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Last Update Date | 08/31/2023
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Provider Practice Location Address
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Address Line | 7620 SW 5TH PL
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City | GAINESVILLE
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State | FL
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Zip | 32607-1572
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Country | US
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Telephone | 808-468-6455
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Fax |
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Provider Business Mailing Address
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Address Line | 7620 SW 5TH PL
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City | GAINESVILLE
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State | FL
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Zip | 32607-1572
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED MEMBER
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Name | JENNIFER MOORE
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Credential | RN, IBCLC
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Telephone | 352-514-0281
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WL0100X
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Taxonomy Name | Lactation Consultant (Registered Nurse)
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License Number |
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License Number State |
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