10D2132120 CLIA NUMBER - TIDES EDGE RECOVERY SERVICES, LLC

Laboratory Demographics

  • CLIA Code: 10D2132120
  • Facility Name: TIDES EDGE RECOVERY SERVICES, LLC
  • Facility Address: 1597 THE GREENS WAY
    JACKSONVILLE, FL
    ZIP 32250
  • Facility Phone: 904 778-6161
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ANDREA TRESCOT
  • NPI Number: 1568985406
  • Taxonomy: 324500000X - Substance Abuse Rehabilitation Facility

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CLIA Record

Field Name Field Value
CLIA Number 10D2132120
LAB Type Physician Office
Facility Name TIDES EDGE RECOVERY SERVICES, LLC
Street 1597 THE GREENS WAY
City JACKSONVILLE
State FL
ZIP 32250
Phone 904 778-6161
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/13/2025
Certificate Expiration Date 6/12/2027
Facility Type Physician Office
Lab Director ANDREA TRESCOT

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