10D2299612 CLIA NUMBER - VIP PRIMARY CARE SERVICES LLC

Laboratory Demographics

  • CLIA Code: 10D2299612
  • Facility Name: VIP PRIMARY CARE SERVICES LLC
  • Facility Address: 1482 N WILSON AVE
    BARTOW, FL
    ZIP 33830
  • Facility Phone: 863 323-2136
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: INGA A. JENNINGS
  • NPI Number: 1508542424
  • Taxonomy: 363LF0000X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 10D2299612
LAB Type Practitioner Other
Facility Name VIP PRIMARY CARE SERVICES LLC
Street 1482 N WILSON AVE
City BARTOW
State FL
ZIP 33830
Phone 863 323-2136
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/23/2024
Certificate Expiration Date 2/22/2026
Facility Type Practitioner Other
Lab Director INGA A. JENNINGS

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This page was last updated on: 9/29/2025