Provider Demographics
NPI:1174200133
Name:MOTHERLAND BIRTHING AND WELLNESS LLC
Entity type:Organization
Organization Name:MOTHERLAND BIRTHING AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRIANA
Authorized Official - Middle Name:MONEZ
Authorized Official - Last Name:BOGGS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, CNM
Authorized Official - Phone:813-365-9454
Mailing Address - Street 1:2501 WALDEN WOODS DR # 3491
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33566-7168
Mailing Address - Country:US
Mailing Address - Phone:813-365-9454
Mailing Address - Fax:813-798-6422
Practice Address - Street 1:2207 VIA CORTONA ST
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33566-1026
Practice Address - Country:US
Practice Address - Phone:813-365-9454
Practice Address - Fax:813-798-6422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty