Provider Demographics
NPI:1881567410
Name:JUST A POKE MOBILE LABS LLC
Entity type:Organization
Organization Name:JUST A POKE MOBILE LABS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:C
Authorized Official - Last Name:BURKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-884-9380
Mailing Address - Street 1:3592 198TH ST
Mailing Address - Street 2:
Mailing Address - City:WELLBORN
Mailing Address - State:FL
Mailing Address - Zip Code:32094-3453
Mailing Address - Country:US
Mailing Address - Phone:904-884-9380
Mailing Address - Fax:
Practice Address - Street 1:118 OHIO AVE N STE A
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32064-2464
Practice Address - Country:US
Practice Address - Phone:904-884-9380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-29
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy