Provider Demographics
NPI:1164813952
Name:TREE OF LIFE BIRTH & GYNECOLOGY
Entity Type:Organization
Organization Name:TREE OF LIFE BIRTH & GYNECOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KALEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP, CNM
Authorized Official - Phone:407-878-2757
Mailing Address - Street 1:1010 ARTHUR AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-2827
Mailing Address - Country:US
Mailing Address - Phone:407-878-2757
Mailing Address - Fax:407-270-7117
Practice Address - Street 1:1010 ARTHUR AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-2827
Practice Address - Country:US
Practice Address - Phone:407-878-2757
Practice Address - Fax:407-270-7117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-15
Last Update Date:2015-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9170873176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty