10D2261037 CLIA NUMBER - MOSAIC MEDICINE, PLLC

Laboratory Demographics

CLIA Number: 10D2261037

Facility Name: MOSAIC MEDICINE, PLLC

Facility Address:
3934 SR 64E
BRADENTON, FL
ZIP 34208
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Facility Phone Number: 941 777-5665

Facility Type: Other - CONCIERGE PRACTICE

Certificate Type: Waiver

NPI Number: 1639827033

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	10D2261037
LAB Type	Other - CONCIERGE PRACTICE
Facility Name	MOSAIC MEDICINE, PLLC
Street	3934 SR 64E
City	BRADENTON
State	FL
ZIP	34208
Phone	941 777-5665
CertificateType	4
CertificateEffectiveDate	5/25/2022
CertificateExpirationDate	5/24/2024
FacilityType	Waiver

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