LIFE EXTENSION CLINICS (NPI# 1861852535) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1861852535 |
Entity Type | Organization |
Organization Name | LIFE EXTENSION CLINICS |
Practice Address |
4130 Salisbury Rd Ste 2400 Jacksonville FL 32216-8052 |
Practice Telephone | 9042961790 |
Enumeration Date | 2016-02-24 |
Last Update Date | 2016-02-24 |
Authorized Official Name | ANTHONY CAPASSO (MEDICAL DIRECTOR) |
Authorized Official Telephone | 9042961790 |
Authorized Official Credential | MD |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 261QX0100X |
Clinic/Center Specialization: Occupational Medicine |
ARNP9414152 | FL | Ambulatory Health Care Facilities |
Entity Type | Entity Name | Entity Address |
---|---|---|
Virginia Business Entities | Life Extension Clinics Inc. | 1011 N Macdill Ave, Tampa, Florida 33607 |
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 |
4130 SALISBURY RD STE 2400 |
City | JACKSONVILLE |
State | FL |
Zip Code | 32216-8052 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1528520749 | Angela Anthony | Preventive Medicine | 4130 Salisbury Rd Ste 2400, Jacksonville, FL 32216-8052 | 2019-04-05 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1013524925 | Renee Cherie Titus | Behavior Technician | Growing Together Center 6789 Southpoint Parkway, Building 100, Jacksonville, FL 32216 | 2020-09-24 |
1811546575 | First Coast Orthopedic Center, LLC | Clinic/Center | 4035 Southpoint Boulevard, Jacksonville, FL 32216 | 2019-09-05 |
1922578558 | Fatima Hussain Crofton | Optometrist | 7051 Southpoint Parkway S 300, Jacksonville, FL 32216 | 2018-11-27 |
1154802833 | John-paul Pham | Internal Medicine | 4141 Southpoint Drive East, Suite D, Jacksonville, FL 32216 | 2018-08-22 |
1790279479 | Joseph Richard Kennedy | Physician Assistant | 6650 Corporate Center Pkwy Apt 1604, Jacksonville, FL 32216 | 2018-06-18 |
1801304357 | Kelli M. Tyson | Nurse Practitioner | 3550 University Blvd. S., Ste 302, Jacksonville, FL 32216 | 2018-01-18 |
1376054809 | Angela M Whittinghill | Counselor | 8833 Perimeter Park Blvd #702, Jacksonville, FL 32216 | 2017-10-24 |
1629508072 | Zoryana Yufan | Dentist | 8750 Perimeter Park Blvd Ste 101, Jacksonville, FL 32216 | 2017-06-19 |
1700318896 | Christina Kaczmarek | Behavior Technician | 6816 Southpoint Pkwy Ste 500, Jacksonville, FL 32216 | 2017-03-29 |
1932640422 | Loudine Racius | Nurse Practitioner | 8539 Gate Parkway W, Unit 1422, Jacksonville, FL 32216 | 2017-03-16 |
Find all providers in zip 32216 |
Taxonomy Code | 261QX0100X |
Grouping | Ambulatory Health Care Facilities |
Classification | Clinic/Center |
Specialization | Occupational Medicine |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1700396181 | Occupational Health Centers of Southwest P.a. | Clinic/Center | 5995-1 University Blvd. West, Jacksonville, FL 32216 | 2017-10-11 |
1396106621 | Access Physical Therapy LLC | Clinic/Center | 8563 Argyle Business Loop, Suite 2, Jacksonville, FL 32244-6668 | 2016-03-15 |
1588982292 | Dolores A Loveless | Clinic/Center | 4933-1 University Blvd W, Jacksonville, FL 32216 | 2010-05-06 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1376197491 | Cano Occupational Medicine, LLC | Clinic/Center | 7911 Nw 72nd Ave Ste 111, Medley, FL 33166-2221 | 2019-07-26 |
1285153429 | Dynamic Theraplay | Clinic/Center | 9278 Legare St, Boca Raton, FL 33434-5905 | 2017-09-19 |
1114455490 | Zamoyski, LLC | Clinic/Center | 17100 Collins Ave Ste 210, Sunny Isles Beach, FL 33160-3675 | 2017-05-31 |
1124564935 | Holy Cross Hospital | Clinic/Center | 10098 Stonehenge Cir Apt 403, Boynton Beach, FL 33437-3542 | 2017-01-18 |
1558743021 | Grant William Fisher | Clinic/Center | 2065 Airport Blvd Ste 300, Pensacola, FL 32504-5930 | 2015-06-22 |
1952780702 | Y&a Medical Center Corp | Clinic/Center | 3750 W 16th Ave Ste 130u, Hialeah, FL 33012-4683 | 2015-05-27 |
1700280559 | Kg Therapy LLC | Clinic/Center | 1015 Spanish River Rd, #304, Boca Raton, FL 33432-7677 | 2014-10-22 |
1295137081 | Bcot Assessment & Sevices, Inc | Clinic/Center | 2100 E.hallandale Bch Blvd., Ste. 101a, Hallandale, FL 33009-3722 | 2014-09-23 |
1578971388 | Lakeside Occupational Medical Centers Inc | Clinic/Center | 12120 Cortez Blvd, Brooksville, FL 34613-5514 | 2014-07-24 |
1164849931 | Community Case Management Services, LLC | Clinic/Center | 815 Nw 57th Ave Ste 400, Miami, FL 33126 | 2014-03-18 |
Find all providers with the same taxonomy |
City | JACKSONVILLE |
Zip Code | 32216 |
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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.