Healthcare Provider Details

I. General information

NPI: 1992591598
Provider Name (Legal Business Name): DIVINE PHLEBOTOMY TRAINING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2025
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5533 LESSER DR
ORLANDO FL
32818-1245
US

IV. Provider business mailing address

5533 LESSER DR
ORLANDO FL
32818-1245
US

V. Phone/Fax

Practice location:
  • Phone: 407-684-6981
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DEVAN CHRISTIAN
Title or Position: OWNER
Credential:
Phone: 407-684-6981