10D2259977 CLIA NUMBER - FAMILY HEALTH PRIMARY CARE PROVIDERS LLC

Laboratory Demographics

CLIA Number: 10D2259977

Facility Name: FAMILY HEALTH PRIMARY CARE PROVIDERS LLC

Facility Address:
1800 PEMBROOKE DR SUITE 300
ORLANDO, FL
ZIP 32810
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Facility Phone Number: 407 814-4466

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1366001901

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	10D2259977
LAB Type	Practitioner Other
Facility Name	FAMILY HEALTH PRIMARY CARE PROVIDERS LLC
Street	1800 PEMBROOKE DR SUITE 300
City	ORLANDO
State	FL
ZIP	32810
Phone	407 814-4466
CertificateType	4
CertificateEffectiveDate	5/13/2024
CertificateExpirationDate	5/12/2026
FacilityType	Waiver

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