10D2233423 CLIA NUMBER - SOUTHERN MAGNOLIA HEALTH AND WELLNESS, LLC

Laboratory Demographics

CLIA Number: 10D2233423

Facility Name: SOUTHERN MAGNOLIA HEALTH AND WELLNESS, LLC

Facility Address:
533 N NOVA RD STE 116
ORMOND BEACH, FL
ZIP 32174
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Facility Phone Number: 386 260-2653

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1871108274

Taxonomy: 363L00000X - Nurse Practitioner
(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

CLIA Record

Field Name	Field Value
CLIA Number	10D2233423
LAB Type	Practitioner Other
Facility Name	SOUTHERN MAGNOLIA HEALTH AND WELLNESS, LLC
Street	533 N NOVA RD STE 116
City	ORMOND BEACH
State	FL
ZIP	32174
Phone	386 260-2653
CertificateType	4
CertificateEffectiveDate	8/23/2023
CertificateExpirationDate	8/22/2025
FacilityType	Waiver

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