Healthcare Provider Details

I. General information

NPI: 1922961168
Provider Name (Legal Business Name): FLORIDA STATE UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 W. CALL STREET, MRB 1320 FLORIDA STATE UNIVERSITY, COLLEGE OF MEDICINE
TALLAHASSEE FL
32306
US

IV. Provider business mailing address

1115 W CALL STREET MRB 2350J FLORIDA STATE UNIVERSITY COLLEGE OF MEDICINE
TALLAHASSEE FL
32306-0001
US

V. Phone/Fax

Practice location:
  • Phone: 850-644-4100
  • Fax:
Mailing address:
  • Phone: 850-645-8491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA VIED
Title or Position: FACULTY
Credential: PHD
Phone: 850-645-8491