Provider Demographics
NPI:1891443446
Name:THE BLISSFUL DOULALA LLC
Entity Type:Organization
Organization Name:THE BLISSFUL DOULALA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:CBD, CPD,CBC
Authorized Official - Phone:352-300-8650
Mailing Address - Street 1:506 KILGORE ST
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34785-3940
Mailing Address - Country:US
Mailing Address - Phone:352-300-8650
Mailing Address - Fax:
Practice Address - Street 1:506 KILGORE ST
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:FL
Practice Address - Zip Code:34785-3940
Practice Address - Country:US
Practice Address - Phone:352-300-8650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-14
Last Update Date:2022-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty