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General NPI Number Information
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NPI Number | 1679487102
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Entity Type | Organization
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Legal Business Name | CORE LIFE LINK INC
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Dates
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Enumeration Date | 10/01/2026
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Last Update Date | 10/01/2026
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Provider Practice Location Address
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Address Line | 945 LANE AVE S
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City | JACKSONVILLE
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State | FL
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Zip | 32205-4706
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Country | US
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Telephone | 844-444-3897
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Fax | 833-445-6962
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Provider Business Mailing Address
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Address Line | 1020 MASON AVE
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-4612
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Country | US
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Telephone | 844-444-3897
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Fax | 833-455-6962
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Authorized Official
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Title or Position | FOUNDER/CEO
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Name | MHAI NANG AGRABA
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Credential | PHARMD
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Telephone | 904-614-8404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | NULL
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State | NULL
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | NULL
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Taxonomy #4
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State | NULL
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Taxonomy #5
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number |
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License Number State | NULL
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Taxonomy #6
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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 | NULL
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