Healthcare Provider Details

I. General information

NPI: 1346365533
Provider Name (Legal Business Name): LIFE CARE DIAGNOSTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 04/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6320 39TH ST
PINELLAS PARK FL
33781-6070
US

IV. Provider business mailing address

PO BOX 40123
ST PETERSBURG FL
33743-0123
US

V. Phone/Fax

Practice location:
  • Phone: 727-522-4433
  • Fax: 727-522-3432
Mailing address:
  • Phone: 727-522-4433
  • Fax: 727-522-3432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: SANDRA LEE NIELSEN
Title or Position: OWNER
Credential:
Phone: 727-522-4433