10D2056719 CLIA NUMBER - AQUA DERMATOLOGY OF FLORIDA PA

Laboratory Demographics

  • CLIA Code: 10D2056719
  • Facility Name: AQUA DERMATOLOGY OF FLORIDA PA
  • Facility Address: 4776 HODGES BLVD STE 105
    JACKSONVILLE, FL
    ZIP 32224
  • Facility Phone: 561 694-9493
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: KENDALL ADKISSON
  • NPI Number: 1194079988
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 10D2056719
LAB Type Physician Office
Facility Name AQUA DERMATOLOGY OF FLORIDA PA
Street 4776 HODGES BLVD STE 105
City JACKSONVILLE
State FL
ZIP 32224
Phone 561 694-9493
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 8/22/2024
Certificate Expiration Date 8/21/2026
Facility Type Physician Office
Lab Director KENDALL ADKISSON

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