10D2241101 CLIA NUMBER - STILL WATERS MEDICAL SPA LLC

Laboratory Demographics

CLIA Number: 10D2241101

Facility Name: STILL WATERS MEDICAL SPA LLC

Facility Address:
20 NORTH TARRAGONA ST
PENSACOLA, FL
ZIP 32502
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Facility Phone Number: 850 432-6772

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1841470895

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	10D2241101
LAB Type	Practitioner Other
Facility Name	STILL WATERS MEDICAL SPA LLC
Street	20 NORTH TARRAGONA ST
City	PENSACOLA
State	FL
ZIP	32502
Phone	850 432-6772
CertificateType	4
CertificateEffectiveDate	10/25/2023
CertificateExpirationDate	10/24/2025
FacilityType	Waiver

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