10D2221994 CLIA NUMBER - GRACE FAMILY PRACTICE

Laboratory Demographics

  • CLIA Code: 10D2221994
  • Facility Name: GRACE FAMILY PRACTICE
  • Facility Address: 6470 TIPPIN AVE
    PENSACOLA, FL
    ZIP 32504
  • Facility Phone: 850 741-2878
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DEBRA A. FICKLING
  • NPI Number: 1932708617
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 10D2221994
LAB Type Physician Office
Facility Name GRACE FAMILY PRACTICE
Street 6470 TIPPIN AVE
City PENSACOLA
State FL
ZIP 32504
Phone 850 741-2878
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/26/2025
Certificate Expiration Date 4/25/2027
Facility Type Physician Office
Lab Director DEBRA A. FICKLING

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