Basic Information
| Provider Information | |||||||||
| NPI: | 1083793046 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LIFE MANAGEMENT INTERNATIONAL INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1267 TIMBERIDGE LOOP N | ||||||||
| Address2: | |||||||||
| City: | LAKELAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338094682 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8636027908 | ||||||||
| FaxNumber: | 8638151901 | ||||||||
| Practice Location | |||||||||
| Address1: | 1267 TIMBERIDGE LOOP N | ||||||||
| Address2: | |||||||||
| City: | LAKELAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338094682 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8636027908 | ||||||||
| FaxNumber: | 8638151901 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2006 | ||||||||
| LastUpdateDate: | 01/04/2013 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | GODWIN | ||||||||
| AuthorizedOfficialFirstName: | PIUS | ||||||||
| AuthorizedOfficialMiddleName: | N. | ||||||||
| AuthorizedOfficialTitleorPosition: | CO-OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8636027908 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | ARNP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | ARNP1921112 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.