Basic Information
| Provider Information | |||||||||
| NPI: | 1619110640 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LIFEFORCE HEALTHCARE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 773176 | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344773176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3528733800 | ||||||||
| FaxNumber: | 3528734800 | ||||||||
| Practice Location | |||||||||
| Address1: | 4460 SW 20TH AVE | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344710163 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3528733800 | ||||||||
| FaxNumber: | 3528734800 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2009 | ||||||||
| LastUpdateDate: | 03/17/2014 | ||||||||
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| AuthorizedOfficialLastName: | WHITTIEMORE | ||||||||
| AuthorizedOfficialFirstName: | MARIANNE | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 3528733800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | ARNP 3064662 | FL | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LA2200X | ARNP 3064782 | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.