Provider Demographics
NPI:1568277788
Name:FLUELLEN, ADREIKA V
Entity type:Individual
Prefix:
First Name:ADREIKA
Middle Name:V
Last Name:FLUELLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 3RD AVE N # 200B
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-3899
Mailing Address - Country:US
Mailing Address - Phone:866-735-8065
Mailing Address - Fax:727-202-7331
Practice Address - Street 1:333 3RD AVE N # 200B
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3899
Practice Address - Country:US
Practice Address - Phone:866-735-8065
Practice Address - Fax:727-202-7331
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25R-CPT251246RP1900X
FL10D2314950247ZC0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physicianGroup - Multi-Specialty
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10D2314950Medicaid