10D0884169 CLIA NUMBER - FLORIDA DEPARTMENT OF HEALTH IN ST JOHNS COUNTY

Laboratory Demographics

  • CLIA Code: 10D0884169
  • Facility Name: FLORIDA DEPARTMENT OF HEALTH IN ST JOHNS COUNTY
  • Facility Address: 200 SAN SEBASTIAN VIEW ATTN CAROL BOLICH
    SAINT AUGUSTINE, FL
    ZIP 32084
  • Facility Phone: 904 825-5055
  • Facility Type: Public Health Laboratories
  • Facility Type: Waiver
  • Lab Director: LISA A. DYNAN - DOBBERTIEN
  • NPI Number: 1093746497
  • Taxonomy: 335E00000X - Prosthetic/Orthotic Supplier

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CLIA Record

Field Name Field Value
CLIA Number 10D0884169
LAB Type Public Health Laboratories
Facility Name FLORIDA DEPARTMENT OF HEALTH IN ST JOHNS COUNTY
Street 200 SAN SEBASTIAN VIEW ATTN CAROL BOLICH
City SAINT AUGUSTINE
State FL
ZIP 32084
Phone 904 825-5055
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/12/2024
Certificate Expiration Date 4/11/2026
Facility Type Public Health Laboratories
Lab Director LISA A. DYNAN - DOBBERTIEN

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