Healthcare Provider Details

I. General information

NPI: 1629992896
Provider Name (Legal Business Name): CLIENT AMENITY DIRECT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2026
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12525 TIBBETS LN UNIT 4410
JACKSONVILLE FL
32218-2696
US

IV. Provider business mailing address

4108 BLANDING BLVD STE C
JACKSONVILLE FL
32210-5419
US

V. Phone/Fax

Practice location:
  • Phone: 470-987-8124
  • Fax:
Mailing address:
  • Phone: 888-257-5784
  • Fax: 904-820-2060

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: SHARLYNE MARSHALL
Title or Position: COMPLIANCE DIRECTOR
Credential:
Phone: 470-987-8124