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904 HEALTH, INC
NPI 1699487678
Clinic/Center - Primary Care in Yulee, FL

Active since December 21, 2022CLIA Certified · 6 labs
96040 LOFTON SQUARE CT, YULEE, FL 32097(904) 659-2475(904) 453-8600 Get Directions Write a Review

NPPES record last updated: April 9, 2025. Verified against the NPPES registry weekly; last sync: September 20, 2026.

Record update history: Apr 9, 2025, Mar 10, 2023, Dec 21, 2022 (3 updates tracked since 2022).

About 904 Health, Inc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

904 HEALTH, INC (NPI 1699487678) is a healthcare organization registered as a primary care in Yulee, Florida and active in the NPI registry since December 2022. The organization holds 6 active CLIA laboratory certificates, maintains 11 additional practice locations, and lists Wendy Kelly, Office Administrator, as its authorized official.

NPPES Registry Identity

NPI1699487678
Entity TypeOrganization
Primary Taxonomy261QP2300X
Legal Business Name904 HEALTH, INC
Location Address96040 LOFTON SQUARE CTYulee, FL 32097-6347
Mailing Address221 N Hogan St Ste 118Jacksonville, FL 32202-4201 · (904) 659-2475 · Fax (904) 453-8600
Phone(904) 659-2475
Fax(904) 453-8600
Organization SubpartNo
Authorized OfficialWendy KellyOffice Administrator · (563) 650-2158
Enumeration DateDecember 21, 2022
Last NPPES UpdateApril 9, 20253 updates tracked since enumeration
NPPES CertifiedApril 9, 2025
✔ NPI 1699487678 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtyClinic/Center · Primary CareAmbulatory Health Care Facilities
Taxonomy Code261QP2300X
Also ListedInternal Medicine · Infectious DiseaseTaxonomy 207RI0200X
Also ListedPublic Health or WelfareTaxonomy 251K00000X
Also ListedClinic/Center · Health ServiceTaxonomy 261QH0100X
96040 LOFTON SQUARE CT, Yulee, FL 32097
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Other Names 1

Other NameManager

Secondary Practice Locations 11

Location 12420 S Highway 29Cantonment, FL 32533-5808 · Phone (904) 900-1513 · Fax (904) 575-4944
Location 23574 US 1 S Ste 101-104St Augustine, FL 32086-6466 · Phone (904) 900-1513 · Fax (904) 575-4944
Location 31241 Blanding Blvd Ste 5Orange Park, FL 32065-5908 · Phone (904) 900-1513 · Fax (904) 575-4944
Location 44427 Emerson St Ste AJacksonville, FL 32207-4969 · Phone (904) 900-1513 · Fax (904) 575-4944
Location 5320 Oakfield DrBrandon, FL 33511-5723 · Phone (904) 900-1513 · Fax (904) 575-4944
Location 61104 E Fowler Ave Unit 100Tampa, FL 33612-5404 · Phone (904) 900-1513 · Fax (904) 575-4944
Location 77207 N Nebraska AveTampa, FL 33604-4916 · Phone (904) 904-1513 · Fax (904) 575-4944
Location 85951 Clark Center Ave Unit BSarasota, FL 34238-2717 · Phone (904) 900-1513 · Fax (904) 575-4944
Location 92102 14th St WBradenton, FL 34205-6351 · Phone (904) 900-1513 · Fax (904) 575-4944
Location 101823 Business Park BlvdDaytona Beach, FL 32114-1230 · Phone (904) 900-1513 · Fax (904) 575-4944
Location 1157 Town Ct Ste 215Palm Coast, FL 32164-2425 · Phone (904) 900-1513 · Fax (904) 575-4944

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA 6

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 10D2317706

904 Health, Inc · Tampa, FL
Active · expires Jan 29, 2027
CLIA Number10D2317706
Laboratory TypeCommunity Clinic
Certificate Effective DateJanuary 30, 2025
Certificate Expiration DateJanuary 29, 2027
Laboratory DirectorPablo Pella
Laboratory Phone(904) 900-1513
Laboratory Location904 Health, Inc7207 N Nebraska, Tampa, FL 33604
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 10D2317537

904 Health, Inc · Bradenton, FL
Active · expires Jan 26, 2027
CLIA Number10D2317537
Laboratory TypeCommunity Clinic
Certificate Effective DateJanuary 27, 2025
Certificate Expiration DateJanuary 26, 2027
Laboratory DirectorPablo Pella
Laboratory Phone(904) 900-1513
Laboratory Location904 Health, Inc2102 14th St, Bradenton, FL 34205
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 10D2316696

904 Health Inc · Cantonment, FL
Active · expires Jan 9, 2027
CLIA Number10D2316696
Laboratory TypeCommunity Clinic
Certificate Effective DateJanuary 10, 2025
Certificate Expiration DateJanuary 9, 2027
Laboratory DirectorPablo Pella
Laboratory Phone(904) 900-1513
Laboratory Location904 Health Inc2420 South Highway 29, Cantonment, FL 32533
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 10D2316410

904 Health, Inc · Tampa, FL
Active · expires Jan 5, 2027
CLIA Number10D2316410
Laboratory TypeCommunity Clinic
Certificate Effective DateJanuary 6, 2025
Certificate Expiration DateJanuary 5, 2027
Laboratory DirectorPablo Pella
Laboratory Phone(904) 900-1513
Laboratory Location904 Health, Inc1104 E Fowler Ave - Ste 100, Tampa, FL 33612
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 10D2315231

904 Health Inc · St Augustine, FL
Active · expires Dec 8, 2026
CLIA Number10D2315231
Laboratory TypeCommunity Clinic
Certificate Effective DateDecember 9, 2024
Certificate Expiration DateDecember 8, 2026
Laboratory DirectorPablo Pella
Laboratory Phone(904) 900-1513
Laboratory Location904 Health Inc3574 Us 1 South Suite 101-104, St Augustine, FL 32086
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 10D2270826

904 Health Inc · Yulee, FL
Active · expires Oct 20, 2026
CLIA Number10D2270826
Laboratory TypeCommunity Clinic
Certificate Effective DateOctober 21, 2024
Certificate Expiration DateOctober 20, 2026
Laboratory DirectorPablo Pella
Laboratory Phone(904) 659-2475
Laboratory Location904 Health Inc96040 Lofton Square Ct, Yulee, FL 32097
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is 904 Health, Inc's NPI number?

The NPI number for 904 Health, Inc is 1699487678. It was assigned to this organization in the NPPES registry on December 21, 2022. The provider is also known as Manager.

Where is 904 Health, Inc located?

904 Health, Inc is located at 96040 Lofton Square Ct, Yulee, FL 32097. The listed phone number is (904) 659-2475.

What is 904 Health, Inc's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.

Does 904 Health, Inc hold CLIA laboratory certificates?

Yes. 6 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for 904 Health, Inc was last updated on April 9, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.