Healthcare Provider Details

I. General information

NPI: 1891651717
Provider Name (Legal Business Name): NEW LIFE TRAINING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 CRYSTAL GROVE BLVD
LUTZ FL
33548-6460
US

IV. Provider business mailing address

210 CRYSTAL GROVE BLVD
LUTZ FL
33548-6460
US

V. Phone/Fax

Practice location:
  • Phone: 813-364-6522
  • Fax: 813-364-6522
Mailing address:
  • Phone: 813-364-6522
  • Fax: 813-364-6522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA MICHAEL MANSAVAGE
Title or Position: ADMINISTRATOR
Credential:
Phone: 813-230-2625