Healthcare Provider Details

I. General information

NPI: 1811655970
Provider Name (Legal Business Name): UTOPIAN LAB SOLUTIONS LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2021
Last Update Date: 02/25/2022
Certification Date: 02/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4016 SOUTH THIRD STREET #1016
JACKSONVILLE BEACH FL
32250-3225
US

IV. Provider business mailing address

5959 FORT CAROLINE RD APT 1702
JACKSONVILLE FL
32277-1842
US

V. Phone/Fax

Practice location:
  • Phone: 904-322-4351
  • Fax: 866-321-0366
Mailing address:
  • Phone: 904-322-4351
  • Fax: 866-321-0366

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: TAMMY WOODS
Title or Position: OWNER
Credential: LPN
Phone: 904-322-4351