ADVANCED LIFE SUPPORT LICENSE
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STATE OF
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DEPARTMENT OF HEALTH
BUREAU OF EMERGENCY MEDICAL SERVICES
ADVANCED LIFE SUPPORT LICENSE
This is to certify that
CLEARWATER, CITY OF
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:
o TRANSPORT
(iSJ NON-TRANSPORT
PINELLAS
County(ies)
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Chief, Bureau of Emergency Medical Services
Florida Department of Health
Date
JUNE 4,2005
Expires
JUNE 3, 2007
DH Form 1161, March 99
This certificate shall be posted in the above mentioned establishment.