Healthcare Provider Details

I. General information

NPI: 1679487102
Provider Name (Legal Business Name): CORE LIFE LINK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 LANE AVE S
JACKSONVILLE FL
32205-4706
US

IV. Provider business mailing address

1020 MASON AVE
DAYTONA BEACH FL
32117-4612
US

V. Phone/Fax

Practice location:
  • Phone: 844-444-3897
  • Fax: 833-445-6962
Mailing address:
  • Phone: 844-444-3897
  • Fax: 833-455-6962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name: MHAI NANG AGRABA
Title or Position: FOUNDER/CEO
Credential: PHARMD
Phone: 904-614-8404