Healthcare Provider Details

I. General information

NPI: 1700543659
Provider Name (Legal Business Name): TREASURED HEARTS LAB SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2021
Last Update Date: 11/25/2021
Certification Date: 11/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2322 NORWOOD PL
TAVARES FL
32778-5102
US

IV. Provider business mailing address

PO BOX 490046
LEESBURG FL
34749-0046
US

V. Phone/Fax

Practice location:
  • Phone: 352-272-3390
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KAI EVANS
Title or Position: OWNER
Credential:
Phone: 352-272-3390