10D1016656 CLIA NUMBER - CONSTANTE FAMILY PRACTICE

Laboratory Demographics

CLIA Number: 10D1016656

Facility Name: CONSTANTE FAMILY PRACTICE

Facility Address:
12400 BRANTLEY COMMONS CT STE 1
FORT MYERS, FL
ZIP 33907
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Facility Phone Number: 239 275-9040

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1437316890

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D1016656
LAB Type	Physician Office
Facility Name	CONSTANTE FAMILY PRACTICE
Street	12400 BRANTLEY COMMONS CT STE 1
City	FORT MYERS
State	FL
ZIP	33907
Phone	239 275-9040
CertificateType	4
CertificateEffectiveDate	9/4/2023
CertificateExpirationDate	9/3/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024