LIFE EXTENSION CLINICS, INC (NPI# 1376869073) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1376869073 |
Entity Type | Organization |
Organization Name | LIFE EXTENSION CLINICS, INC |
Other Organization Name | LIFE SCAN WELLNESS CENTERS |
Practice Address |
1011 N Macdill Ave Tampa FL 33607-5126 |
Practice Telephone | 8138760625 |
Practice Fax Number | 8138760653 |
Mailing Telephone | 8138760625 |
Mailing Fax Number | 8138760653 |
Enumeration Date | 2010-04-20 |
Last Update Date | 2010-04-20 |
Authorized Official Name | PATRICIA JOHNSON (CEO) |
Authorized Official Telephone | 8138760625 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 163WG0000X |
Registered Nurse Specialization: General Practice |
RN1456802 | FL | Nursing Service Providers |
Other Name | Type Code |
---|---|
Life Scan Wellness Centers | Doing Business As Name - Organization |
Entity Type | Entity Name | Entity Address |
---|---|---|
Washington State Corporations | LIFE EXTENSION CLINICS, INC. | 1011 N Macdill Ave, Tampa, FL 33607-5126 |
Colorado Business Entities | Life Extension Clinics, Inc. | 1011 North Macdill Ave., Yampa, FL 33607 |
Street Address |
1011 N MACDILL AVE |
City | TAMPA |
State | FL |
Zip Code | 33607-5126 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1215535737 | Amy Koehler | Nurse Practitioner | 1011 N Macdill Ave, Tampa, FL 33607-5126 | 2020-10-16 |
1306495387 | Barbara Ann Palinchik | Nurse Practitioner | 1011 N Macdill Ave, Tampa, FL 33607-5126 | 2019-09-11 |
1376190785 | Marci Vitale | Nurse Practitioner | 1011 N Macdill Ave, Tampa, FL 33607-5126 | 2019-08-20 |
1740748987 | Jennifer Lopez | Nurse Practitioner | 1011 N Macdill Ave, Tampa, FL 33607-5126 | 2019-03-06 |
1366942708 | Lisa Marie Simms | Nurse Practitioner | 1011 N Macdill Ave, Tampa, FL 33607-5126 | 2018-02-12 |
1679014401 | Kathryn Bacher | Nurse Practitioner | 1011 N Macdill Ave, Tampa, FL 33607-5126 | 2017-03-13 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1326656265 | Sky City Pharmacy LLC | Pharmacy | 2812 W. Dr Martin Luther King Jr Blvd, Tampa, FL 33607 | 2020-07-16 |
1821614413 | Tammy Sue Alleyn | Social Worker | 4414 N. Armenia Av., Tampa, FL 33607 | 2020-06-19 |
1912528290 | Advanced Mobile Medical Services | Clinic/Center | 2136 W. Mlk Blvd, Tampa, FL 33607 | 2020-04-28 |
1659909232 | Rachel Sobiech | Social Worker | 2006 Pan Am Circle, Suite 270, Tampa, FL 33607 | 2020-03-30 |
1295379733 | Melizza Liz Sanchez Ayala | Registered Nurse | 1701 N Lois Avenue, Valera Apt Unit 224, Tampa, FL 33607 | 2019-10-28 |
1720647191 | Caretyme LLC | Clinic/Center | 1923 West St. John Street, Tampa, FL 33607 | 2019-06-10 |
1720545981 | Amante Medical and Diabetic Center, P.a. | Internal Medicine | 1001 N Macdill Ave. Suite B, Tampa, FL 33607 | 2019-02-25 |
1609360908 | Misty Dawn Ray Ross | Social Worker | 2902 N Armenia Ave Ste 200, Tampa, FL 33607 | 2018-06-20 |
1255825154 | Kenneth Konrad Schirer | Physical Therapist | 2700 W Dr. Mlk Blvd, Suite 300, Tampa, FL 33607 | 2018-06-14 |
1902314875 | Cardiac Cin of Florida, LLC | Internal Medicine | 3001 W Martin Luther King Jr Blvd, Tampa, FL 33607 | 2018-01-13 |
Find all providers in zip 33607 |
Taxonomy Code | 163WG0000X |
Grouping | Nursing Service Providers |
Classification | Registered Nurse |
Specialization | General Practice |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1942642301 | Yanet D. Perez Parra | Registered Nurse | 6821 W Hillsborough Ave Ste 10-11, Tampa, FL 33634 | 2013-07-25 |
1902158611 | Christopher Colton Mitchell | Registered Nurse | 1109 W Peninsular St, Tampa, FL 33603-5213 | 2012-10-04 |
1326038621 | Alice H Pandolfi | Registered Nurse | 14602 Corkwood Dr, Tampa, FL 33626-2334 | 2005-10-27 |
1861093759 | Alma Escalona | Registered Nurse | 5707 N 22nd St, Tampa, FL 33610-4350 | 2020-11-05 |
1215407671 | Mayelin Gonzalez | Registered Nurse | 205 W Busch Blvd, Tampa, FL 33612-7900 | 2018-11-28 |
1093284507 | Tiffany Kendra Whiting | Registered Nurse | 1 Tampa General Cir, Tampa, FL 33606-3571 | 2018-11-14 |
1669920237 | Miguel Mestre Jr. | Registered Nurse | 13000 Bruce B Downs Blvd, Tampa, FL 33612-4745 | 2016-09-13 |
1316902323 | Ileana Fernandez | Registered Nurse | 13000 Bruce B Downs Blvd, Cardiology 111-a, Tampa, FL 33612-4745 | 2006-04-20 |
1326041419 | Penny G Lee | Registered Nurse | 1 Tampa General Cir, Hmt Cardiology, Tampa, FL 33606-3571 | 2005-05-23 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1073113973 | Carlos Josue Felico Pupo Sr. | Registered Nurse | 10405 Old Cutler Rd Apt 202, Cutler Bay, FL 33190-1708 | 2020-10-29 |
1659979920 | Kelsey Coons | Registered Nurse | 1105 Shenandoah Ct, Marco Island, FL 34145-5021 | 2020-10-09 |
1134736085 | Kenneth E Knowles | Registered Nurse | 1515 E Hewett Rd, Santa Rosa Beach, FL 32459-3348 | 2020-09-24 |
1043826688 | Gregory Wade Prince | Registered Nurse | 1790 Waterside Oaks Dr, Orange City, FL 32763-9206 | 2020-09-18 |
1699381483 | Charissa Elizabeth Carroll | Registered Nurse | 1639 Songbird Ct, Naples, FL 34120-1652 | 2020-09-17 |
1447862586 | Teresa Koliha | Registered Nurse | 4251 N Bay Rd, Miami Beach, FL 33140-2844 | 2020-08-19 |
1295344604 | Portia Williams | Registered Nurse | 2225 Sw Newport Isles Blvd, Port St Lucie, FL 34953-4575 | 2020-07-31 |
1093323610 | Linda Marie Mcmurray | Registered Nurse | 1539 Parental Home Rd Ste 5, Jacksonville, FL 32216-3009 | 2020-07-20 |
1255949160 | Maria A Oliver | Registered Nurse | 8365 Sw 152nd Ave Apt C-108, Miami, FL 33193-4028 | 2020-07-16 |
1700401635 | Dakota Sharon Phillips Wheeler | Registered Nurse | 5045 Kirkwood Trl, Titusville, FL 32780-6717 | 2020-06-16 |
Find all providers with the same taxonomy |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.