Provider Demographics
NPI:1023747086
Name:JENSEN, ESHIVA NAYA (LM, CPM)
Entity type:Individual
Prefix:
First Name:ESHIVA
Middle Name:NAYA
Last Name:JENSEN
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 TEAL LN
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4746
Mailing Address - Country:US
Mailing Address - Phone:850-524-0236
Mailing Address - Fax:
Practice Address - Street 1:260 E 6TH AVE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-6208
Practice Address - Country:US
Practice Address - Phone:850-224-2229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW434176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife