Provider Demographics
NPI:1295254241
Name:HEALTHLINE ESSENTIALS LLC
Entity type:Organization
Organization Name:HEALTHLINE ESSENTIALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTIONER-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN COLLIS
Authorized Official - Middle Name:VALDEZ
Authorized Official - Last Name:LACY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:210-459-6514
Mailing Address - Street 1:8905 EVENING STAR DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134-8806
Mailing Address - Country:US
Mailing Address - Phone:210-459-6514
Mailing Address - Fax:702-453-7005
Practice Address - Street 1:8905 EVENING STAR DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89134-8806
Practice Address - Country:US
Practice Address - Phone:210-459-6514
Practice Address - Fax:702-453-7005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN002311363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty