10D2235395 CLIA NUMBER - CARING HEART FAMILY NURSE PRACTITIONER PLLC

Laboratory Demographics

  • CLIA Code: 10D2235395
  • Facility Name: CARING HEART FAMILY NURSE PRACTITIONER PLLC
  • Facility Address: 4721 E MOODY BLVD STE 103
    BUNNELL, FL
    ZIP 32110
  • Facility Phone: 239 222-8065
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: EVANGELINE BUTLER
  • NPI Number: 1043801772
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 10D2235395
LAB Type Physician Office
Facility Name CARING HEART FAMILY NURSE PRACTITIONER PLLC
Street 4721 E MOODY BLVD STE 103
City BUNNELL
State FL
ZIP 32110
Phone 239 222-8065
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/9/2023
Certificate Expiration Date 9/8/2025
Facility Type Physician Office
Lab Director EVANGELINE BUTLER

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This page was last updated on: 3/20/2025