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General NPI Number Information
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NPI Number | 1073393963
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Entity Type | Organization
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Legal Business Name | ADVANCE LABS LLC
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Dates
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Enumeration Date | 09/29/2023
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Last Update Date | 10/18/2024
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Provider Practice Location Address
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Address Line | 305 W CRAWFORD ST
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City | QUINCY
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State | FL
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Zip | 32351-3121
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Country | US
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Telephone | 954-651-3919
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Fax |
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Provider Business Mailing Address
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Address Line | 3275 EMERSON LN
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City | TALLAHASSEE
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State | FL
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Zip | 32317-9044
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Country | US
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Telephone | 954-651-3919
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TINA M WRIGHT
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Credential | PHLEBOTOMY
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Telephone | 954-651-3919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374700000X
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Taxonomy Name | Technician
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License Number |
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License Number State |
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