10D2243272 CLIA NUMBER - INTEGRATIVE DIRECT PRIMARY CARE, INC

Laboratory Demographics

CLIA Number: 10D2243272

Facility Name: INTEGRATIVE DIRECT PRIMARY CARE, INC

Facility Address:
2590 NORTHBROOKE PLAZA DRIVE SUITE 106
NAPLES, FL
ZIP 34119
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Facility Phone Number: 239 350-4900

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1366014086

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	10D2243272
LAB Type	Practitioner Other
Facility Name	INTEGRATIVE DIRECT PRIMARY CARE, INC
Street	2590 NORTHBROOKE PLAZA DRIVE SUITE 106
City	NAPLES
State	FL
ZIP	34119
Phone	239 350-4900
CertificateType	4
CertificateEffectiveDate	11/17/2023
CertificateExpirationDate	11/16/2025
FacilityType	Waiver

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