10D0702360 CLIA NUMBER - MILLENNIUM PHYSICIAN GROUP LLC

Laboratory Demographics

  • CLIA Code: 10D0702360
  • Facility Name: MILLENNIUM PHYSICIAN GROUP LLC
  • Facility Address: 725 SIXTH ST S
    MACCLENNY, FL
    ZIP 32063
  • Facility Phone: 941 787-7665
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: WHITNEY NIMMO-OLSEN
  • NPI Number: 1235801986
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 10D0702360
LAB Type Physician Office
Facility Name MILLENNIUM PHYSICIAN GROUP LLC
Street 725 SIXTH ST S
City MACCLENNY
State FL
ZIP 32063
Phone 941 787-7665
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/2/2023
Certificate Expiration Date 11/1/2025
Facility Type Physician Office
Lab Director WHITNEY NIMMO-OLSEN

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