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General NPI Number Information
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NPI Number | 1336819788
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Entity Type | Organization
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Legal Business Name | P31 LIFE LLC
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Dates
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Enumeration Date | 09/16/2021
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Last Update Date | 02/13/2026
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Provider Practice Location Address
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Address Line | 4951 E HIGHWAY 20
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City | NICEVILLE
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State | FL
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Zip | 32578-8844
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Country | US
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Telephone | 850-299-9943
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Fax |
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Provider Business Mailing Address
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Address Line | 4516 E HIGHWAY 20 # 168
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City | NICEVILLE
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State | FL
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Zip | 32578-9755
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Country | US
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Telephone | 305-924-5397
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DIANNE SMITH
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Credential | CRNP
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Telephone | 863-455-7300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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