MEDICARE: ESSENCE OF LIFE HEALTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1013555077
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ESSENCE OF LIFE HEALTH LLC

Provider Business Mailing Address
First Line	:	4343 N AUSTRALIAN AVE
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-3623
Country	:	US
Telephone Number	:	248-688-4460
Fax Number	:

Provider Business Practice Location Address
First Line	:	3860 SHERIDAN ST STE B
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-3624
Country	:	US
Telephone Number	:	248-688-4460
Fax Number	:

Authorized Official
Title or Position	:	NURSE PRACTIONER/OWNER
Name	:	EBONI DAVIS
Credential	:	FNP-BC
Telephone Number	:	248-688-4460

Provider Enumeration Date	:	12/20/2019
Last Update Date	:	11/23/2022

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Directions to “ESSENCE OF LIFE HEALTH LLC ” Practice Location

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