10D2249883 CLIA NUMBER - PREMIER HEALTH PLUS, LLC

Laboratory Demographics

CLIA Number: 10D2249883

Facility Name: PREMIER HEALTH PLUS, LLC

Facility Address:
3691 TAMIAMI TRAIL
PUNTA GORDA, FL
ZIP 33950
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Facility Phone Number: 239 810-1859

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1043972102

Taxonomy: 363LP2300X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	10D2249883
LAB Type	Physician Office
Facility Name	PREMIER HEALTH PLUS, LLC
Street	3691 TAMIAMI TRAIL
City	PUNTA GORDA
State	FL
ZIP	33950
Phone	239 810-1859
CertificateType	4
CertificateEffectiveDate	1/24/2024
CertificateExpirationDate	1/23/2026
FacilityType	Waiver

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