MEDICARE: MS. JENNIE SUSAN JOSEPH LM, CPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker
2	374J00000X	Doula
3	176B00000X	Midwife	MW0053	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205833266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIE SUSAN JOSEPH LM, CPM

Provider Business Mailing Address
First Line	:	213 S DILLARD ST
Second Line	:	SUITE 340
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-3596
Country	:	US
Telephone Number	:	407-656-6938
Fax Number	:	407-656-9161

Provider Business Practice Location Address
First Line	:	213 S. DILLARD ST
Second Line	:	SUITE 340
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-2922
Country	:	US
Telephone Number	:	407-656-6938
Fax Number	:	407-656-9161

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2005
Last Update Date	:	12/13/2018

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