10D2263743 CLIA NUMBER - ST PETE NURSE PRACTITIONER, LLC

Laboratory Demographics

CLIA Number: 10D2263743

Facility Name: ST PETE NURSE PRACTITIONER, LLC

Facility Address:
33 4TH ST N SUITE 202
SAINT PETERSBURG, FL
ZIP 33701
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Facility Phone Number: 727 686-8284

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1720724297

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2263743
LAB Type	Physician Office
Facility Name	ST PETE NURSE PRACTITIONER, LLC
Street	33 4TH ST N SUITE 202
City	SAINT PETERSBURG
State	FL
ZIP	33701
Phone	727 686-8284
CertificateType	4
CertificateEffectiveDate	7/5/2022
CertificateExpirationDate	7/4/2024
FacilityType	Waiver

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