Provider Demographics
NPI:1164971917
Name:JACINDA GOLDEN
Entity Type:Organization
Organization Name:JACINDA GOLDEN
Other - Org Name:RIVER CITY HOMEBIRTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:JACINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:LM, CPM
Authorized Official - Phone:904-505-4848
Mailing Address - Street 1:9439 SAN JOSE BLVD
Mailing Address - Street 2:APT 3
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-9233
Mailing Address - Country:US
Mailing Address - Phone:904-505-4848
Mailing Address - Fax:904-339-9335
Practice Address - Street 1:9439 SAN JOSE BLVD
Practice Address - Street 2:APT 3
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-9233
Practice Address - Country:US
Practice Address - Phone:904-505-4848
Practice Address - Fax:904-339-9335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW315176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty