10D2090232 CLIA NUMBER - AZALEA TRACE PHYSICIAN SERVICES

Laboratory Demographics

  • CLIA Code: 10D2090232
  • Facility Name: AZALEA TRACE PHYSICIAN SERVICES
  • Facility Address: 10100 HILLVIEW DR
    PENSACOLA, FL
    ZIP 32514
  • Facility Phone: 850 478-5200
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JESSICA B. CAMPOSAGRADO
  • NPI Number: 1417292251
  • Taxonomy: 253Z00000X - In Home Supportive Care

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CLIA Record

Field Name Field Value
CLIA Number 10D2090232
LAB Type Physician Office
Facility Name AZALEA TRACE PHYSICIAN SERVICES
Street 10100 HILLVIEW DR
City PENSACOLA
State FL
ZIP 32514
Phone 850 478-5200
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/16/2025
Certificate Expiration Date 1/15/2027
Facility Type Physician Office
Lab Director JESSICA B. CAMPOSAGRADO

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