Healthcare Provider Details

I. General information

NPI: 1790137982
Provider Name (Legal Business Name): LIFEXL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2016
Last Update Date: 04/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5602 MARQUESAS CIR STE 107
SARASOTA FL
34233-3310
US

IV. Provider business mailing address

5602 MARQUESAS CIR STE 107
SARASOTA FL
34233-3310
US

V. Phone/Fax

Practice location:
  • Phone: 941-266-4469
  • Fax:
Mailing address:
  • Phone: 941-702-5972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. LAZO PIPOVSKI
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 941-702-5972