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Individual

STACIA LAROSE GODBOLDT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
CNM

Contact information

Practice address
300 HEALTH PARK BLVD STE 3002, ST AUGUSTINE, FL 32086-3703
(904) 819-1500
Mailing address
184 OAK SHADOW PL, SAINT JOHNS, FL 32259-7425
(904) 652-7298

Taxonomy

Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
Primary

Other

Enumeration date
03/01/2023
Last updated
03/02/2023
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