Healthcare Provider Details

I. General information

NPI: 1447921234
Provider Name (Legal Business Name): HEART OF GOLD SUPERIOR LAB SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2021
Last Update Date: 12/13/2022
Certification Date: 12/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W STATE ROAD 436 STE 2151
ALTAMONTE SPRINGS FL
32714-3056
US

IV. Provider business mailing address

801 W STATE ROAD 436 STE 2151
ALTAMONTE SPRINGS FL
32714-3056
US

V. Phone/Fax

Practice location:
  • Phone: 407-461-9200
  • Fax:
Mailing address:
  • Phone: 407-461-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MS. CHRISTINA NICHOLE HARVEY
Title or Position: OWNER
Credential:
Phone: 407-461-9200