10D2052171 CLIA NUMBER - NASSAU COUNTY WIC PROGRAM HILLIARD CLINIC

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Laboratory Demographics

CLIA Number: 10D2052171

Facility Name: NASSAU COUNTY WIC PROGRAM HILLIARD CLINIC

Facility Address:
37203 PECAN ST
HILLIARD, FL
ZIP 32046
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Facility Phone Number: 904 845-2660

Facility Type: Other - WIC CLINIC

Certificate Type: Waiver

NPI Number: 1124494638

Taxonomy: 261QM0801X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2052171
LAB Type	Other - WIC CLINIC
Facility Name	NASSAU COUNTY WIC PROGRAM HILLIARD CLINIC
Street	37203 PECAN ST
City	HILLIARD
State	FL
ZIP	32046
Phone	904 845-2660
CertificateType	4
CertificateEffectiveDate	1/7/2023
CertificateExpirationDate	1/6/2025
FacilityType	Waiver

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