Provider Demographics
NPI:1871953398
Name:WILLOUGHBY MIDWIFERY LLC
Entity type:Organization
Organization Name:WILLOUGHBY MIDWIFERY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:DARLENE
Authorized Official - Last Name:WILLOUGHBY
Authorized Official - Suffix:
Authorized Official - Credentials:LM
Authorized Official - Phone:727-895-2300
Mailing Address - Street 1:1405 DR MARTIN LUTHER KING JR ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-3301
Mailing Address - Country:US
Mailing Address - Phone:727-895-2300
Mailing Address - Fax:727-491-7086
Practice Address - Street 1:1405 DR MARTIN LUTHER KING JR ST N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-3301
Practice Address - Country:US
Practice Address - Phone:727-895-2300
Practice Address - Fax:727-491-7086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL357261QB0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing