Provider Demographics
NPI:1790497931
Name:PHILOSTIN, MIRIAM (DOULA)
Entity Type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:
Last Name:PHILOSTIN
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 SWEET BRIAR LN
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33410-1909
Mailing Address - Country:US
Mailing Address - Phone:561-377-2001
Mailing Address - Fax:
Practice Address - Street 1:1000 SWEET BRIAR LN
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410-1909
Practice Address - Country:US
Practice Address - Phone:561-377-2001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula