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General NPI Number Information
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NPI Number | 1083793046
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Entity Type | Organization
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Legal Business Name | LIFE MANAGEMENT INTERNATIONAL INC.
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 01/04/2013
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Provider Practice Location Address
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Address Line | 1267 TIMBERIDGE LOOP N
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City | LAKELAND
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State | FL
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Zip | 33809-4682
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Country | US
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Telephone | 863-602-7908
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Fax | 863-815-1901
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Provider Business Mailing Address
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Address Line | 1267 TIMBERIDGE LOOP N
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City | LAKELAND
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State | FL
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Zip | 33809-4682
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Country | US
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Telephone | 863-602-7908
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Fax | 863-815-1901
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Authorized Official
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Title or Position | CO-OWNER
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Name | PIUS N. GODWIN
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Credential | ARNP
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Telephone | 863-602-7908
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | ARNP1921112
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License Number State | FL
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