Provider Demographics
NPI:1215781398
Name:DISCH, VIRGINIA (LM, CPM)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:DISCH
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 1:224 FLORIDA BLVD
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32266-4969
Mailing Address - Country:US
Mailing Address - Phone:217-552-0631
Mailing Address - Fax:
Practice Address - Street 1:830 3RD ST S STE 108
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-6674
Practice Address - Country:US
Practice Address - Phone:904-834-1155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL461176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife