Organization Active NPI

Core Life Link Inc

  • Infectious Disease Physician
  • Jacksonville, FL
National Provider Identifier
1679487102
Registry record updated Oct 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
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, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
CORE LIFE LINK INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 1, 2026

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

Authorized official

Name
Mhai Nang Agraba, PHARMDNPI 1457231292
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)CodeLicenseStatePrimary
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.

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.

Verify at the official NPI Registry.