Provider Demographics
NPI:1205187267
Name:CANOSA, JALIEET M (LICENSED MIDWIFE)
Entity Type:Individual
Prefix:
First Name:JALIEET
Middle Name:M
Last Name:CANOSA
Suffix:
Gender:F
Credentials:LICENSED MIDWIFE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:726 SE 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-2917
Mailing Address - Country:US
Mailing Address - Phone:973-557-8052
Mailing Address - Fax:
Practice Address - Street 1:726 SE 12TH AVE
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-2917
Practice Address - Country:US
Practice Address - Phone:973-557-8052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-30
Last Update Date:2012-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW257176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMW257OtherLICENSED MIDWIFE