10D2294198 CLIA NUMBER - BALANCE WELLNESS & PRIMARY CARE

Laboratory Demographics

CLIA Number: 10D2294198

Facility Name: BALANCE WELLNESS & PRIMARY CARE

Facility Address:
21754 FL-54 - STE 102
LUTZ, FL
ZIP 33549
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Facility Phone Number: 813 344-3948

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1912635111

Taxonomy: 363LF0000X - Nurse Practitioner

CLIA Record

Field Name	Field Value
CLIA Number	10D2294198
LAB Type	Physician Office
Facility Name	BALANCE WELLNESS & PRIMARY CARE
Street	21754 FL-54 - STE 102
City	LUTZ
State	FL
ZIP	33549
Phone	813 344-3948
CertificateType	4
CertificateEffectiveDate	11/20/2023
CertificateExpirationDate	11/19/2025
FacilityType	Waiver

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