ADVANCED LIFE SUPPORT LICENSE
This is to certify that
00.1827
FLORIDA
STATE OF ..
ADVANCED LIFE SUPPORT LICENSE
BUREAU OF EMERGENCY MEDICAL SERVICES
DEPARTMENT OF HEALTH
CITY OF CLEARWATER
Name of ProVIder
610 FRANKLIN STREET, CLEARWATER, FL 33756
Address
has complied with Chapter 401, Florida Statutes and Chapter 64E-2, Florida Administrative Code, and is authorized to operate as an
Advanced Life Support Service subject to any and all limitations specified in applicable Certificate(s) of Public Convenience and
Necessity for the County(ies) listed below:
PINELLAS
o Interfacility
Ground Transport
o Prehospital
Air-Rotor Wmg
o Interfacility
Air-Fixed Wmg
o Prehospital
Ground Transport
[!] Prehospital
Ground Nontransport
o Interfacility.
Air-Rotor Wmg
DINO J. VILLANI
Director
Date
JUNE 4. 1999
JUNE 3. 2001
Expires
DOH Form 1161, Feb 97 (Replaces Nov 93 edition)
This certificate shall be posted in the above listed establishment.
.