Healthcare Provider Details

I. General information

NPI: 1801519590
Provider Name (Legal Business Name): BLOODLNK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 FLAGLER AVE
KEY WEST FL
33040-3934
US

IV. Provider business mailing address

2505 FLAGLER AVE
KEY WEST FL
33040-3934
US

V. Phone/Fax

Practice location:
  • Phone: 305-587-4894
  • Fax:
Mailing address:
  • Phone: 305-896-0879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: JJAY D GRAZETTE
Title or Position: OWNER
Credential:
Phone: 305-587-4894