Provider Demographics
NPI:1295371896
Name:NEST LIFE, LLC
Entity type:Organization
Organization Name:NEST LIFE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:PHELPS
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:727-201-2309
Mailing Address - Street 1:360 CENTRAL AVE STE 800
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-3984
Mailing Address - Country:US
Mailing Address - Phone:727-201-2389
Mailing Address - Fax:855-224-4326
Practice Address - Street 1:360 CENTRAL AVE STE 800
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3984
Practice Address - Country:US
Practice Address - Phone:727-201-2389
Practice Address - Fax:855-224-4326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-19
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL109269900Medicaid