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General NPI Number Information
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NPI Number | 1992263107
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Entity Type | Organization
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Legal Business Name | ENVISION LIFE MEDICAL LLC
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Dates
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Enumeration Date | 03/06/2019
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Last Update Date | 06/12/2020
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Provider Practice Location Address
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Address Line | 101 N US HIGHWAY 1 STE 207
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City | FORT PIERCE
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State | FL
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Zip | 34950-4256
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Country | US
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Telephone | 772-228-1190
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Fax | 855-205-6117
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Provider Business Mailing Address
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Address Line | 101 N US HIGHWAY 1 STE 207
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City | FORT PIERCE
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State | FL
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Zip | 34950-4256
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Country | US
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Telephone | 772-228-1190
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Fax | 855-205-6117
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Authorized Official
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Title or Position | OWNER
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Name | OMAR FERMIN
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Credential |
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Telephone | 772-228-1190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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