10D2081536 CLIA NUMBER - LIGHTHOUSE PEDIATRICS

Laboratory Demographics

  • CLIA Code: 10D2081536
  • Facility Name: LIGHTHOUSE PEDIATRICS
  • Facility Address: 4475 US HWY 1 SOUTH SUITE 100
    SAINT AUGUSTINE, FL
    ZIP 32086
  • Facility Phone: 904 342-7648
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JESSICA L. STAILEY
  • NPI Number: 1043630353
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 10D2081536
LAB Type Physician Office
Facility Name LIGHTHOUSE PEDIATRICS
Street 4475 US HWY 1 SOUTH SUITE 100
City SAINT AUGUSTINE
State FL
ZIP 32086
Phone 904 342-7648
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/28/2024
Certificate Expiration Date 7/27/2026
Facility Type Physician Office
Lab Director JESSICA L. STAILEY

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