10D2162058 CLIA NUMBER - ST AUGUSTINE PRIMARY CARE PL

Laboratory Demographics

  • CLIA Code: 10D2162058
  • Facility Name: ST AUGUSTINE PRIMARY CARE PL
  • Facility Address: 811 SR 206 E UNIT #3
    ST AUGUSTINE, FL
    ZIP 32086
  • Facility Phone: 904 342-2989
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JUDITH L. NICHOLS
  • NPI Number: 1760654370
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 10D2162058
LAB Type Physician Office
Facility Name ST AUGUSTINE PRIMARY CARE PL
Street 811 SR 206 E UNIT #3
City ST AUGUSTINE
State FL
ZIP 32086
Phone 904 342-2989
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/15/2025
Certificate Expiration Date 2/14/2027
Facility Type Physician Office
Lab Director JUDITH L. NICHOLS

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