Provider Demographics
NPI:1013555077
Name:ESSENCE OF LIFE HEALTH LLC
Entity Type:Organization
Organization Name:ESSENCE OF LIFE HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTIONER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EBONI
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:248-688-4460
Mailing Address - Street 1:4343 N AUSTRALIAN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-3623
Mailing Address - Country:US
Mailing Address - Phone:248-688-4460
Mailing Address - Fax:
Practice Address - Street 1:3860 SHERIDAN ST STE B
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3624
Practice Address - Country:US
Practice Address - Phone:248-688-4460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-20
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty