Provider Demographics
NPI:1174284038
Name:LIFE TREE WOMEN CARE, INC.
Entity Type:Organization
Organization Name:LIFE TREE WOMEN CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MEDICAL PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, CNM
Authorized Official - Phone:904-379-2540
Mailing Address - Street 1:5500 BLANDING BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-1946
Mailing Address - Country:US
Mailing Address - Phone:904-379-2540
Mailing Address - Fax:904-379-2541
Practice Address - Street 1:5500 BLANDING BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-1946
Practice Address - Country:US
Practice Address - Phone:904-379-2540
Practice Address - Fax:904-379-2541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-04
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, AmbulatoryGroup - Multi-Specialty
No261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care