10D2262140 CLIA NUMBER - EXPRESS PROVIDER SERVICES PLLC

Laboratory Demographics

  • CLIA Code: 10D2262140
  • Facility Name: EXPRESS PROVIDER SERVICES PLLC
  • Facility Address: 8130 LAKEWOOD MAIN ST SUITE 103
    LAKEWOOD RANCH, FL
    ZIP 34202
  • Facility Phone: 407 221-1679
  • Facility Type: Mobile Laboratory
  • Facility Type: Waiver
  • Lab Director: ASHLEY R. RALEY
  • NPI Number: 1427793181
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 10D2262140
LAB Type Mobile Laboratory
Facility Name EXPRESS PROVIDER SERVICES PLLC
Street 8130 LAKEWOOD MAIN ST SUITE 103
City LAKEWOOD RANCH
State FL
ZIP 34202
Phone 407 221-1679
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/9/2024
Certificate Expiration Date 6/8/2026
Facility Type Mobile Laboratory
Lab Director ASHLEY R. RALEY

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