10D2126082 CLIA NUMBER - SACRED HEART CLINIC AT WALGREENS

Laboratory Demographics

CLIA Number: 10D2126082

Facility Name: SACRED HEART CLINIC AT WALGREENS

Facility Address:
6314 N 9TH AVE
PENSACOLA, FL
ZIP 32504
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Facility Phone Number: 850 416-4730

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1205376480

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	10D2126082
LAB Type	Practitioner Other
Facility Name	SACRED HEART CLINIC AT WALGREENS
Street	6314 N 9TH AVE
City	PENSACOLA
State	FL
ZIP	32504
Phone	850 416-4730
CertificateType	4
CertificateEffectiveDate	2/21/2023
CertificateExpirationDate	2/20/2025
FacilityType	Waiver

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