Healthcare Provider Details

I. General information

NPI: 1568277788
Provider Name (Legal Business Name): ADREIKA V FLUELLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2025
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 3RD AVE N # 200B
SAINT PETERSBURG FL
33701-3899
US

IV. Provider business mailing address

333 3RD AVE N # 200B
SAINT PETERSBURG FL
33701-3899
US

V. Phone/Fax

Practice location:
  • Phone: 866-735-8065
  • Fax: 727-202-7331
Mailing address:
  • Phone: 866-735-8065
  • Fax: 727-202-7331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number25R-CPT251
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number10D2314950
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: