Provider Demographics
NPI:1083793046
Name:LIFE MANAGEMENT INTERNATIONAL INC.
Entity Type:Organization
Organization Name:LIFE MANAGEMENT INTERNATIONAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PIUS
Authorized Official - Middle Name:N
Authorized Official - Last Name:GODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:863-602-7908
Mailing Address - Street 1:1267 TIMBERIDGE LOOP N
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33809-4682
Mailing Address - Country:US
Mailing Address - Phone:863-602-7908
Mailing Address - Fax:863-815-1901
Practice Address - Street 1:1267 TIMBERIDGE LOOP N
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33809-4682
Practice Address - Country:US
Practice Address - Phone:863-602-7908
Practice Address - Fax:863-815-1901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1921112363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6037Medicare ID - Type Unspecified