Healthcare Provider Details

I. General information

NPI: 1205191442
Provider Name (Legal Business Name): FLL DIAGNOSTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2012
Last Update Date: 06/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2331 NE 53RD ST
FT LAUDERDALE FL
33308-3235
US

IV. Provider business mailing address

PO BOX 7240
JUPITER FL
33468-7240
US

V. Phone/Fax

Practice location:
  • Phone: 954-491-9700
  • Fax:
Mailing address:
  • Phone: 561-748-2889
  • Fax: 561-748-1523

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: KAREN BARLOW
Title or Position: JUPITER PROFESSIONAL DEVELOPMENT
Credential: PRESIDENT
Phone: 561-748-2889