Provider Demographics
NPI:1376193839
Name:JACKSONVILLE COMMUNITY MIDWIVES LLC
Entity Type:Organization
Organization Name:JACKSONVILLE COMMUNITY MIDWIVES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:LM, CPM, LPN, CLC
Authorized Official - Phone:904-203-8559
Mailing Address - Street 1:2301 PARK AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-5558
Mailing Address - Country:US
Mailing Address - Phone:904-203-8559
Mailing Address - Fax:904-592-5282
Practice Address - Street 1:2301 PARK AVE STE 203
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5558
Practice Address - Country:US
Practice Address - Phone:904-203-8559
Practice Address - Fax:904-592-5282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-17
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty