Healthcare Provider Details

I. General information

NPI: 1043010119
Provider Name (Legal Business Name): EVERLIFE HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 BERMUDA ISLES CIR
VENICE FL
34292-4510
US

IV. Provider business mailing address

407 BERMUDA ISLES CIR
VENICE FL
34292-4510
US

V. Phone/Fax

Practice location:
  • Phone: 917-528-1304
  • Fax:
Mailing address:
  • Phone: 917-528-1304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ALEKSANDR BUKHBINDER
Title or Position: MANAGER
Credential: APRN
Phone: 917-528-1304