Provider Demographics
NPI:1578061438
Name:MIDWIFE HOPE TERRELL LLC
Entity Type:Organization
Organization Name:MIDWIFE HOPE TERRELL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAFFINI
Authorized Official - Middle Name:HOPE
Authorized Official - Last Name:TERRELL
Authorized Official - Suffix:
Authorized Official - Credentials:LM,CPM
Authorized Official - Phone:904-476-2999
Mailing Address - Street 1:4714 BIRKENHEAD RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-4138
Mailing Address - Country:US
Mailing Address - Phone:904-450-3697
Mailing Address - Fax:904-339-9011
Practice Address - Street 1:4714 BIRKENHEAD RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-4138
Practice Address - Country:US
Practice Address - Phone:904-450-3697
Practice Address - Fax:904-339-9011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL210176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty