Active NPI
Core Life Link Inc
- Infectious Disease Physician
- Jacksonville, FL
National Provider Identifier
1679487102
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Infectious Disease Physician
- Legal business name
- CORE LIFE LINK INC
- Practice address
- 945 Lane Ave S
Jacksonville, FL 32205-4706 - Phone
- (844) 444-3897
- Fax
- (833) 445-6962
- NPI assigned
- Oct 1, 2026
- Last updated
- Oct 1, 2026
- Organization subpart
- Yes
- Parent organization
- CORE LIFE LINK INC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mhai Nang Agraba, PHARMD
- Title
- Founder/Ceo
- Phone
- (904) 614-8404
Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.
Specialties & licenses 6
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | NU | ||
| Nurse Practitioner | 363L00000X | NU | ||
| Family Medicine Physician | 207Q00000X | NU | ||
| Infectious Disease Physician | 207RI0200X | NU | Primary | |
| Public Health & General Preventive Medicine Physician | 2083P0901X | NU | ||
| Case Manager/Care Coordinator | 171M00000X | NU |
Addresses
Primary practice location
945 Lane Ave S
Jacksonville, FL 32205-4706
Mailing address
1020 Mason Ave
Daytona Beach, FL 32117-4612
Phone (844) 444-3897
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Pharmacist
- Daytona Beach, FL
- NPI 1457231292
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1790812800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1790812800000",
"number": "1679487102",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1020 MASON AVE",
"city": "DAYTONA BEACH",
"state": "FL",
"postal_code": "321174612",
"telephone_number": "844-444-3897",
"fax_number": "833-455-6962"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "945 LANE AVE S",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322054706",
"telephone_number": "844-444-3897",
"fax_number": "833-445-6962"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CORE LIFE LINK INC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "CORE LIFE LINK INC",
"enumeration_date": "2026-10-01",
"last_updated": "2026-10-01",
"certification_date": "2026-10-01",
"status": "A",
"authorized_official_last_name": "AGRABA",
"authorized_official_first_name": "MHAI",
"authorized_official_middle_name": "NANG",
"authorized_official_title_or_position": "FOUNDER/CEO",
"authorized_official_telephone_number": "904-614-8404",
"authorized_official_credential": "PHARMD"
},
"taxonomies": [
{
"code": "261Q00000X",
"taxonomy_group": "",
"desc": "Clinic/Center",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "207RI0200X",
"taxonomy_group": "",
"desc": "Internal Medicine, Infectious Disease",
"state": "NU",
"license": null,
"primary": true
},
{
"code": "2083P0901X",
"taxonomy_group": "",
"desc": "Preventive Medicine, Public Health & General Preventive Medicine",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.