Healthcare Provider Details

I. General information

NPI: 1750108692
Provider Name (Legal Business Name): ACCUCOLLECT LABS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9924 AZALEA BLOOM WAY APT 406
RIVERVIEW FL
33578
US

IV. Provider business mailing address

11232 BOYETTE RD # 1044
RIVERVIEW FL
33569-8009
US

V. Phone/Fax

Practice location:
  • Phone: 833-324-4268
  • Fax:
Mailing address:
  • Phone: 833-324-4268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID NELSON
Title or Position: AMBR
Credential:
Phone: 407-717-8806