Provider Demographics
NPI:1245095835
Name:FERTILE GROUND MIDWIFERY
Entity type:Organization
Organization Name:FERTILE GROUND MIDWIFERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIFINI
Authorized Official - Middle Name:
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-296-7086
Mailing Address - Street 1:2241 N MONROE ST # 1295
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-4731
Mailing Address - Country:US
Mailing Address - Phone:850-296-7086
Mailing Address - Fax:850-792-1354
Practice Address - Street 1:6130 TRAILWOOD CT
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32311-9389
Practice Address - Country:US
Practice Address - Phone:850-296-7086
Practice Address - Fax:850-792-1354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110520600Medicaid