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General NPI Number Information
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NPI Number | 1578439980
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Entity Type | Organization
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Legal Business Name | MEDICERT PRO LLC
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Dates
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Enumeration Date | 10/13/2025
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Last Update Date | 10/13/2025
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Provider Practice Location Address
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Address Line | 17218 TOLEDO BLADE BLVD UNIT 10
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City | PORT CHARLOTTE
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State | FL
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Zip | 33954-2615
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Country | US
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Telephone | 941-280-0844
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Fax | 941-894-0416
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Provider Business Mailing Address
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Address Line | 17218 TOLEDO BLADE BLVD UNIT 10
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City | PORT CHARLOTTE
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State | FL
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Zip | 33954-2615
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Country | US
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Telephone | 941-280-0844
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Fax | 941-894-0416
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Authorized Official
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Title or Position | LAB DIRECTOR
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Name | DERLUNE SAINTVIL
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Credential | PHLEBOTOMIST
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Telephone | 941-280-0844
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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