Provider Demographics
NPI:1073104824
Name:ELEPHANT TRIBE
Entity Type:Organization
Organization Name:ELEPHANT TRIBE
Other - Org Name:JEN THE DOULA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JENIFFER
Authorized Official - Middle Name:
Authorized Official - Last Name:REVELL
Authorized Official - Suffix:
Authorized Official - Credentials:DOULA
Authorized Official - Phone:470-798-7145
Mailing Address - Street 1:1717 NE 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-3210
Mailing Address - Country:US
Mailing Address - Phone:470-798-7145
Mailing Address - Fax:
Practice Address - Street 1:1717 NE 28TH AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-3210
Practice Address - Country:US
Practice Address - Phone:470-798-7145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-02
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty
No174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty