MEDICARE: TLC PHLEBTOMY SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246RP1900X	Phlebotomy Technician

General Provider Information

NPI Number	:	1134936966
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TLC PHLEBTOMY SERVICES LLC

Provider Business Mailing Address
First Line	:	656 LINWOOD AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32206-6249
Country	:	US
Telephone Number	:	205-615-4381
Fax Number	:

Provider Business Practice Location Address
First Line	:	413 PALM ST
Second Line	:
City	:	GREEN COVE SPRINGS
State	:	FL
Zip	:	32043-2736
Country	:	US
Telephone Number	:	205-615-4381
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TAMYCA EPTING
Credential	:	PHLEBOTOMIST
Telephone Number	:	205-615-4381

Provider Enumeration Date	:	12/16/2024
Last Update Date	:	12/16/2024

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