Provider Demographics
NPI:1588360747
Name:CLOVER LEAF MIDWIFERY, LLC
Entity type:Organization
Organization Name:CLOVER LEAF MIDWIFERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MIDWIFE, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:DIBARTOLO-BARCLAY
Authorized Official - Suffix:
Authorized Official - Credentials:LM, LMT
Authorized Official - Phone:352-218-9288
Mailing Address - Street 1:18865 STATE ROAD 54
Mailing Address - Street 2:STE 181
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-8201
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:813-536-3061
Practice Address - Street 1:4020 BLUE LANTANA LN
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-3561
Practice Address - Country:US
Practice Address - Phone:727-387-3939
Practice Address - Fax:813-536-3061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty