10D2244188 CLIA NUMBER - SEADIPITY WELLNESS LLC

Laboratory Demographics

  • CLIA Code: 10D2244188
  • Facility Name: SEADIPITY WELLNESS LLC
  • Facility Address: 22455 FLORA PARKE BLVD
    FERNANDINA BEACH, FL
    ZIP 32034
  • Facility Phone: 904 453-4790
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: ANGELA W. ODONNELL
  • NPI Number: 1336803642
  • Taxonomy: 363LP2300X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 10D2244188
LAB Type Practitioner Other
Facility Name SEADIPITY WELLNESS LLC
Street 22455 FLORA PARKE BLVD
City FERNANDINA BEACH
State FL
ZIP 32034
Phone 904 453-4790
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/30/2023
Certificate Expiration Date 11/29/2025
Facility Type Practitioner Other
Lab Director ANGELA W. ODONNELL

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