# BLUELIFE MEDICAL, INC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205706751
- **Authorized official:** MR. JONATHAN L CORPUS MD, MBA (OWNER)
- **Authorized official phone:** (701) 818-7630

## Contact information

- **Practice address:** 4850 TAMIAMI TRL N, SUITE 301, NAPLES, FL 34103-3029
- **Practice address phone:** (239) 778-6958
- **Mailing address:** 4850 TAMIAMI TRL N, SUITE 301, NAPLES, FL 34103-3029
- **Mailing address phone:** (239) 778-6958

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QP0002X | Physician Nutrition Specialist (Family Medicine) | — | NULL | Yes |
| 207QP0002X | Physician Nutrition Specialist (Family Medicine) | — | — | Yes |

## Other

- **Enumeration date:** 11/10/2025
- **Last updated:** 11/10/2025