MEDICARE: HEALTHY LIFELINE LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	363LF0000X	Family Nurse Practitioner
2	261QP2300X	Primary Care Clinic/Center
3	363L00000X	Nurse Practitioner
4	207R00000X	Internal Medicine Physician
5	207RA0201X	Allergy & Immunology (Internal Medicine) Physician
6	207RC0200X	Critical Care Medicine (Internal Medicine) Physician
7	207RI0200X	Infectious Disease Physician
8	363LP2300X	Primary Care Nurse Practitioner

General Provider Information

NPI Number	:	1629871744
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHY LIFELINE LLC

Provider Business Mailing Address
First Line	:	3557 WINTER WREN ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89122-3539
Country	:	US
Telephone Number	:	702-782-7828
Fax Number	:

Provider Business Practice Location Address
First Line	:	3557 WINTER WREN ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89122-3539
Country	:	US
Telephone Number	:	702-782-7828
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	JOHN MARIUS TOLENTINO
Credential	:	APRN
Telephone Number	:	702-445-4092

Provider Enumeration Date	:	04/01/2025
Last Update Date	:	04/01/2025

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Directions to “HEALTHY LIFELINE LLC ” Practice Location

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