10D2247199 CLIA NUMBER - FLORIDA BLUE STAR, INC

Laboratory Demographics

  • CLIA Code: 10D2247199
  • Facility Name: FLORIDA BLUE STAR, INC
  • Facility Address: 1325 SE 47TH ST UNIT 1 SUITE 1
    CAPE CORAL, FL
    ZIP 33904
  • Facility Phone: 239 205-2337
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: IRVING HERNANDEZ
  • NPI Number: 1053993550
  • Taxonomy: 363LP2300X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 10D2247199
LAB Type Physician Office
Facility Name FLORIDA BLUE STAR, INC
Street 1325 SE 47TH ST UNIT 1 SUITE 1
City CAPE CORAL
State FL
ZIP 33904
Phone 239 205-2337
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/5/2024
Certificate Expiration Date 1/4/2026
Facility Type Physician Office
Lab Director IRVING HERNANDEZ

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