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General NPI Number Information
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NPI Number | 1114377918
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Entity Type | Organization
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Legal Business Name | CORE LIFESTYLE
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Dates
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Enumeration Date | 06/13/2016
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Last Update Date | 06/13/2016
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Provider Practice Location Address
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Address Line | 3383 AQUA RIDGE WAY
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City | TALLAHASSEE
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State | FL
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Zip | 32309-4809
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Country | US
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Telephone | 850-510-6677
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Fax |
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Provider Business Mailing Address
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Address Line | 3383 AQUA RIDGE WAY
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City | TALLAHASSEE
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State | FL
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Zip | 32309-4809
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MATTHEW EVERS
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Credential |
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Telephone | 850-597-5170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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