Provider Demographics
NPI:1508331349
Name:SUNSHINE STATE MIDWIFERY SERVICES
Entity Type:Organization
Organization Name:SUNSHINE STATE MIDWIFERY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MIDWIFE
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:M
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:LM, CPM, LPN
Authorized Official - Phone:904-717-4994
Mailing Address - Street 1:1988 ASHTON ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-6915
Mailing Address - Country:US
Mailing Address - Phone:904-717-4994
Mailing Address - Fax:904-758-5338
Practice Address - Street 1:1988 ASHTON ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-6915
Practice Address - Country:US
Practice Address - Phone:904-717-4994
Practice Address - Fax:904-758-5338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-08
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100152100Medicaid