Provider Demographics
NPI:1790961688
Name:BIRTH AND BEYOND BIRTH CENTER
Entity Type:Organization
Organization Name:BIRTH AND BEYOND BIRTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:LENAS
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP,CNM,FNP
Authorized Official - Phone:386-659-2104
Mailing Address - Street 1:PO BOX 380129
Mailing Address - Street 2:
Mailing Address - City:GRANDIN
Mailing Address - State:FL
Mailing Address - Zip Code:32138-0129
Mailing Address - Country:US
Mailing Address - Phone:386-659-2104
Mailing Address - Fax:
Practice Address - Street 1:1326 SR 100
Practice Address - Street 2:
Practice Address - City:GRANDIN
Practice Address - State:FL
Practice Address - Zip Code:32138
Practice Address - Country:US
Practice Address - Phone:386-659-2104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL796842367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLB0123OtherBCBS