Healthcare Provider Details

I. General information

NPI: 1881567410
Provider Name (Legal Business Name): JUST A POKE MOBILE LABS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2025
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 OHIO AVE N STE A
LIVE OAK FL
32064-2464
US

IV. Provider business mailing address

3592 198TH ST
WELLBORN FL
32094-3453
US

V. Phone/Fax

Practice location:
  • Phone: 904-884-9380
  • Fax:
Mailing address:
  • Phone: 904-884-9380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TAYLOR C BURKER
Title or Position: OWNER
Credential:
Phone: 904-884-9380