# LIFE EXTENSION CLINICS

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

## Provider details

- **NPI number:** 1861852535
- **Authorized official:** ANTHONY CAPASSO MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (904) 296-1790

## Contact information

- **Practice address:** 4130 SALISBURY RD STE 2400, JACKSONVILLE, FL 32216-8052
- **Practice address phone:** (904) 296-1790
- **Mailing address:** 4130 SALISBURY RD STE 2400, JACKSONVILLE, FL 32216-8052

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QX0100X | Occupational Medicine Clinic/Center | ARNP9414152 | FL | Yes |

## Other

- **Enumeration date:** 02/24/2016
- **Last updated:** 02/24/2016