Provider Demographics
NPI:1417729716
Name:INNERCOASTAL WELLNESS LLC
Entity Type:Organization
Organization Name:INNERCOASTAL WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/LEAD DOULA
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, CD(DONA)
Authorized Official - Phone:678-294-3369
Mailing Address - Street 1:2295 EAGLES NEST RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-1002
Mailing Address - Country:US
Mailing Address - Phone:678-294-3369
Mailing Address - Fax:
Practice Address - Street 1:2295 EAGLES NEST RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-1002
Practice Address - Country:US
Practice Address - Phone:678-294-3369
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty