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General NPI Number Information
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NPI Number | 1417786450
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Entity Type | Organization
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Legal Business Name | TREE OF LYFE CONSULTING LLC
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Dates
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Enumeration Date | 07/29/2024
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Last Update Date | 07/29/2024
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Provider Practice Location Address
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Address Line | 109 EDGE CT
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City | GROVELAND
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State | FL
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Zip | 34736-2520
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Country | US
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Telephone | 352-973-0693
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Fax |
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Provider Business Mailing Address
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Address Line | 711 W MAIN ST # 1056
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City | LEESBURG
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State | FL
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Zip | 34748-5128
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Country | US
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Telephone | 352-973-0693
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DEBREA S BOSTIC
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Credential |
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Telephone | 352-973-0693
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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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Taxonomy #2
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Taxonomy Code | 246RP1900X
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Taxonomy Name | Phlebotomy Technician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 293D00000X
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Taxonomy Name | Physiological Laboratory
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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