NPIMap

Organization Active NPI

Life Extension Clinics, Inc

  • General Practice Registered Nurse
  • Tampa, FL
National Provider Identifier
1376869073
Registry record updated Apr 20, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice Registered NurseTaxonomy code 163WG0000X
License
RN1456802 Issued in FL
Legal business name
LIFE EXTENSION CLINICS, INC
Practice address
1011 N Macdill Ave
Tampa, FL 33607-5126
Phone
(813) 876-0625
Fax
(813) 876-0653
NPI assigned
Apr 20, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Patricia Johnson
Title
Ceo
Phone
(813) 876-0625

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Registered NurseGroup: 193400000X SINGLE SPECIALTY GROUP 163WG0000X RN1456802 FL Primary

Addresses

Primary practice location

1011 N Macdill Ave
Tampa, FL 33607-5126

Mailing address

1011 N Macdill Ave
Tampa, FL 33607-5126
Phone (813) 876-0625

Other names 1

  • Life Scan Wellness Centers Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Life Extension Clinics2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1011 N Macdill Ave
Tampa, FL 33607
Phone (813) 876-0625

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1271721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1271721600000",
    "number": "1376869073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1011 N MACDILL AVE",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336075126",
            "telephone_number": "813-876-0625",
            "fax_number": "813-876-0653"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 N MACDILL AVE",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336075126",
            "telephone_number": "813-876-0625",
            "fax_number": "813-876-0653"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE EXTENSION CLINICS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-20",
        "last_updated": "2010-04-20",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "813-876-0625"
    },
    "taxonomies": [
        {
            "code": "163WG0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Registered Nurse, General Practice",
            "state": "FL",
            "license": "RN1456802",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Life Scan Wellness Centers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tampa, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.