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General NPI Number Information
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NPI Number | 1578456224
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Entity Type | Organization
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Legal Business Name | DAKOTA DIAGNOSTICS LLC
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Dates
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Enumeration Date | 06/02/2025
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Last Update Date | 09/04/2025
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Provider Practice Location Address
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Address Line | 226 S MARION AVE
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City | LAKE CITY
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State | FL
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Zip | 32025-7058
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Country | US
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Telephone | 866-332-5682
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Fax | 866-332-5682
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Provider Business Mailing Address
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Address Line | 250 NW MAIN BLVD STE 12
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City | LAKE CITY
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State | FL
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Zip | 32055-3380
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Country | US
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Telephone | 866-332-5682
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Fax | 866-332-5682
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Authorized Official
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Title or Position | CEO
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Name | TA'SHEIKA JACKSON
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Credential | CMA, CPT, MT, IV TEC
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Telephone | 866-332-5682
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246RP1900X
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Taxonomy Name | Phlebotomy Technician
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License Number |
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License Number State |
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