Provider Demographics
NPI:1760990055
Name:BIRTH COLLECTIVE OF JACKSONVILLE
Entity Type:Organization
Organization Name:BIRTH COLLECTIVE OF JACKSONVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MIDWIFE/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHEA
Authorized Official - Middle Name:
Authorized Official - Last Name:CINTRON
Authorized Official - Suffix:
Authorized Official - Credentials:LM, CNM
Authorized Official - Phone:904-633-3333
Mailing Address - Street 1:684 TIMBERMILL LN
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-2231
Mailing Address - Country:US
Mailing Address - Phone:904-633-3333
Mailing Address - Fax:
Practice Address - Street 1:684 TIMBERMILL LN
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-2231
Practice Address - Country:US
Practice Address - Phone:904-633-3333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-20
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty