Healthcare Provider Details

I. General information

NPI: 1710793849
Provider Name (Legal Business Name): CORELIFESOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2024
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10550 BAYMEADOWS RD UNIT 430
JACKSONVILLE FL
32256-4526
US

IV. Provider business mailing address

9 OLD KINGS RD N STE 123
PALM COAST FL
32137-4603
US

V. Phone/Fax

Practice location:
  • Phone: 904-490-0902
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. LINDA D WATSON
Title or Position: CEO
Credential: ARNP
Phone: 904-490-0902