Provider Demographics
NPI:1730772823
Name:ATLANTIC COAST PHLEBOTOMY INSTRUCTION LLC
Entity type:Organization
Organization Name:ATLANTIC COAST PHLEBOTOMY INSTRUCTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CAROLLO
Authorized Official - Suffix:
Authorized Official - Credentials:PHLEBOTOMIST
Authorized Official - Phone:561-929-1373
Mailing Address - Street 1:814 COCHRAN DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-5709
Mailing Address - Country:US
Mailing Address - Phone:156-192-9137
Mailing Address - Fax:
Practice Address - Street 1:814 COCHRAN DR
Practice Address - Street 2:
Practice Address - City:LAKE WORTH BEACH
Practice Address - State:FL
Practice Address - Zip Code:33461-5709
Practice Address - Country:US
Practice Address - Phone:561-929-1373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health