MEDICARE: LIFELINK FOUNDATION INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	80001111	FL

General Provider Information

NPI Number	:	1629070917
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFELINK FOUNDATION INC

Provider Business Mailing Address
First Line	:	9661 DELANEY CREEK BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-5121
Country	:	US
Telephone Number	:	813-253-2640
Fax Number	:	813-258-8356

Provider Business Practice Location Address
First Line	:	9661 DELANEY CREEK BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-5121
Country	:	US
Telephone Number	:	813-253-2640
Fax Number	:	813-253-8356

Authorized Official
Title or Position	:	CFO
Name	:	MR. PATRICK BRISLEY
Credential	:
Telephone Number	:	813-804-4525

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	05/12/2025

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Directions to “LIFELINK FOUNDATION INC ” Practice Location

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