Organization
FLO-MEDILAB SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAQUELYN ALICE AGASAN PHD (MANAGING DIRECTOR/OWNER)
(407) 369-8125
Entity
Organization
Contact information
Practice address
716 HUGHEY ST UNIT B, KISSIMMEE, FL 34741-5626
(844) 356-6334
(512) 532-0923
Mailing address
716 HUGHEY ST UNIT B, KISSIMMEE, FL 34741-5626
(844) 356-6334
(512) 532-0923
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
10D2093547
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10D2093547
CLIA
FL
Enumeration date
04/21/2015
Last updated
01/13/2021
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