MEDICARE: BREATH OF LIFE INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	363LW0102X	Women's Health Nurse Practitioner
2	363LX0001X	Obstetrics & Gynecology Nurse Practitioner
3	367A00000X	Advanced Practice Midwife

General Provider Information

NPI Number	:	1073624730
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BREATH OF LIFE INC

Provider Business Mailing Address
First Line	:	1900 E BAY DR
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33771-2218
Country	:	US
Telephone Number	:	727-216-1420
Fax Number	:	727-216-1418

Provider Business Practice Location Address
First Line	:	1900 E BAY DR
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33771-2218
Country	:	US
Telephone Number	:	727-216-1420
Fax Number	:	727-216-1418

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	GLENDA PEARSON
Credential	:
Telephone Number	:	727-422-6599

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	05/09/2023

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Directions to “BREATH OF LIFE INC ” Practice Location

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