Individual
JENNIFER BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
IBCLC
Contact information
Practice address
829 W MLK BLVD STE 256, TAMPA, FL 33603-3309
(803) 807-3454
Mailing address
829 W MLK BLVD STE 256, TAMPA, FL 33603-3309
(803) 807-7810
Taxonomy
Speciality
Code
Description
License number
State
171400000X
Health & Wellness Coach
—
—
172V00000X
Community Health Worker
—
—
174H00000X
Health Educator
—
—
174N00000X
Lactation Consultant (Non-RN)
Primary
L-72574
—
Other
Enumeration date
06/18/2021
Last updated
02/06/2024
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