MEDICARE: CORELIFESOLUTIONS LLC

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	261QU0200X	Urgent Care Clinic/Center
2	171400000X	Health & Wellness Coach

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710793849
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORELIFESOLUTIONS LLC

Provider Business Mailing Address
First Line	:	9 OLD KINGS RD N STE 123
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32137-4603
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10550 BAYMEADOWS RD UNIT 430
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-4526
Country	:	US
Telephone Number	:	904-490-0902
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. LINDA D WATSON
Credential	:	ARNP
Telephone Number	:	904-490-0902

Provider Enumeration Date	:	12/04/2024
Last Update Date	:	12/04/2024

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Directions to “CORELIFESOLUTIONS LLC ” Practice Location

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