10D2174634 CLIA NUMBER - PREMISE HEALTH OF FLORIDA MEDICAL, PA

Laboratory Demographics

  • CLIA Code: 10D2174634
  • Facility Name: PREMISE HEALTH OF FLORIDA MEDICAL, PA
  • Facility Address: 4340 NEWBERRY RD STE 203
    GAINESVILLE, FL
    ZIP 32607
  • Facility Phone: 352 663-9136
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JONATHAN TAFFE
  • NPI Number: 1346883196
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 10D2174634
LAB Type Physician Office
Facility Name PREMISE HEALTH OF FLORIDA MEDICAL, PA
Street 4340 NEWBERRY RD STE 203
City GAINESVILLE
State FL
ZIP 32607
Phone 352 663-9136
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/5/2023
Certificate Expiration Date 11/4/2025
Facility Type Physician Office
Lab Director JONATHAN TAFFE

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