10D2275003 CLIA NUMBER - ELLIS PEDIATRICS, PLLC

Laboratory Demographics

  • CLIA Code: 10D2275003
  • Facility Name: ELLIS PEDIATRICS, PLLC
  • Facility Address: 12086 FORT CAROLINE RD - STE 401
    JACKSONVILLE, FL
    ZIP 32225
  • Facility Phone: 904 456-9240
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KENYANITA ELLIS
  • NPI Number: 1134844426
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 10D2275003
LAB Type Physician Office
Facility Name ELLIS PEDIATRICS, PLLC
Street 12086 FORT CAROLINE RD - STE 401
City JACKSONVILLE
State FL
ZIP 32225
Phone 904 456-9240
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/13/2025
Certificate Expiration Date 1/12/2027
Facility Type Physician Office
Lab Director KENYANITA ELLIS

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