Provider Demographics
NPI:1578969200
Name:HOLISTIC MATERNITY, LLC
Entity Type:Organization
Organization Name:HOLISTIC MATERNITY, LLC
Other - Org Name:HOLISTIC MATERNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:K
Authorized Official - Last Name:HOLLON
Authorized Official - Suffix:
Authorized Official - Credentials:LM, CPM
Authorized Official - Phone:727-565-8798
Mailing Address - Street 1:10460 ROOSEVELT BLVD N
Mailing Address - Street 2:SUITE 179
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-3821
Mailing Address - Country:US
Mailing Address - Phone:727-565-8798
Mailing Address - Fax:727-497-7913
Practice Address - Street 1:10460 ROOSEVELT BLVD N
Practice Address - Street 2:SUITE 179
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-3821
Practice Address - Country:US
Practice Address - Phone:727-565-8798
Practice Address - Fax:727-497-7913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW268176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006618000Medicaid