10D2141806 CLIA NUMBER - COASTLINE MEDICAL SERVICES, PLCC

Laboratory Demographics

  • CLIA Code: 10D2141806
  • Facility Name: COASTLINE MEDICAL SERVICES, PLCC
  • Facility Address: 1817 LEWIS TURNER BLVD SUITE F
    FORT WALTON BEACH, FL
    ZIP 32547
  • Facility Phone: 850 396-1110
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: MICHAEL E. TAVERNARIS
  • NPI Number: 1003361767
  • Taxonomy: 261QM2500X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 10D2141806
LAB Type Physician Office
Facility Name COASTLINE MEDICAL SERVICES, PLCC
Street 1817 LEWIS TURNER BLVD SUITE F
City FORT WALTON BEACH
State FL
ZIP 32547
Phone 850 396-1110
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/21/2023
Certificate Expiration Date 12/20/2025
Facility Type Physician Office
Lab Director MICHAEL E. TAVERNARIS

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