Healthcare Provider Details

I. General information

NPI: 1912603648
Provider Name (Legal Business Name): KRL PHLEBOTOMIST AND MEDICAL CONCIERGE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2023
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2037 N UNIVERSITY DR
SUNRISE FL
33322-3936
US

IV. Provider business mailing address

PO BOX 246175
PEMBROKE PINES FL
33024-0119
US

V. Phone/Fax

Practice location:
  • Phone: 885-539-9948
  • Fax: 888-553-9994
Mailing address:
  • Phone: 885-539-9948
  • Fax: 888-553-9994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LATOYA VAANESSA NICHOLAS ALEXNADER
Title or Position: MBG
Credential:
Phone: 885-539-9948