Healthcare Provider Details

I. General information

NPI: 1538640685
Provider Name (Legal Business Name): SOUTHERN OASIS LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2018
Last Update Date: 03/08/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2527 10TH AVE S
SAINT PETERSBURG FL
33712-2021
US

IV. Provider business mailing address

2527 10TH AVE S
SAINT PETERSBURG FL
33712-2021
US

V. Phone/Fax

Practice location:
  • Phone: 727-743-7463
  • Fax: 727-898-5850
Mailing address:
  • Phone: 727-743-7463
  • Fax: 727-898-5850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN5151587
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LILLIAN BAKER
Title or Position: CEO
Credential:
Phone: 727-743-7463