Organization
LIFE EXTENSION CLINICS, INC
Active
Other names
Life Scan Wellness Centers
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICIA JOHNSON (CEO)
(813) 876-0625
Entity
Organization
Contact information
Practice address
1011 N MACDILL AVE, TAMPA, FL 33607-5126
(813) 876-0625
(813) 876-0653
Mailing address
1011 N MACDILL AVE, TAMPA, FL 33607-5126
(813) 876-0625
(813) 876-0653
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
RN1456802
FL
Other
Enumeration date
04/20/2010
Last updated
04/20/2010
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