10D0681600 CLIA NUMBER - LAKE INTERNAL MEDICINE ASSOCIATES PA

Laboratory Demographics

  • CLIA Code: 10D0681600
  • Facility Name: LAKE INTERNAL MEDICINE ASSOCIATES PA
  • Facility Address: 2101 PREVATT ST
    EUSTIS, FL
    ZIP 32726
  • Facility Phone: 352 589-4774
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: STEVEN M. TANG
  • NPI Number: 1679595649
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 10D0681600
LAB Type Physician Office
Facility Name LAKE INTERNAL MEDICINE ASSOCIATES PA
Street 2101 PREVATT ST
City EUSTIS
State FL
ZIP 32726
Phone 352 589-4774
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/21/2024
Certificate Expiration Date 12/20/2026
Facility Type Physician Office
Lab Director STEVEN M. TANG

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This page was last updated on: 9/29/2025