Life Extension Clinics

Primary specialty

Occupational Medicine Clinic/CenterTaxonomy code 261QX0100X

License

ARNP9414152 Issued in FL

Legal business name

LIFE EXTENSION CLINICS

Practice address

4130 Salisbury Rd Ste 2400
Jacksonville, FL 32216-8052

Phone

(904) 296-1790

NPI assigned

Feb 24, 2016

Organization subpart

No

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

Authorized official

Name

Anthony Capasso, MD

Title

Medical Director

Phone

(904) 296-1790

Specialties & licenses 1

Addresses

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.

• Life Extension Clinics, Inc

  • General Practice Registered Nurse
  • Tampa, FL
  • NPI 1376869073
  NPD tax ID

Locations

Practitioners 1

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

• Amber Michelle Crossley, ARNP

  • Nurse Practitioner
  • Jacksonville, FL
  • NPI 1790136646
  NPD (past)

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

{
    "created_epoch": "1456272000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1456272000000",
    "number": "1861852535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4130 SALISBURY RD STE 2400",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322168052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4130 SALISBURY RD STE 2400",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322168052",
            "telephone_number": "904-296-1790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE EXTENSION CLINICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-24",
        "last_updated": "2016-02-24",
        "status": "A",
        "authorized_official_last_name": "CAPASSO",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "904-296-1790",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QX0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Occupational Medicine",
            "state": "FL",
            "license": "ARNP9414152",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas John Liesegang, M.D.
• Life and Longevity Homecare LLC
• Life Assistance and Management Agency
• Life Changing Solutions
• Life Counseling Center, Inc.
• Life Journey Counseling, LLC
• Life Line Health Partners, LLC
• Life Line Home Care Inc
• Life Mission Chiropractic Inc
• Life Skills Learning Services

• Occupational Medicine Clinic/Center in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Occupational Medicine Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2016; 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.