10D2302842 CLIA NUMBER - TUPELO PRIMARY CARE

Laboratory Demographics

  • CLIA Code: 10D2302842
  • Facility Name: TUPELO PRIMARY CARE
  • Facility Address: 412 N HWY 71
    WEWAHITCHKA, FL
    ZIP 32465
  • Facility Phone: 850 639-4036
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: AMY L. MILLER
  • NPI Number: 1649976770
  • Taxonomy: 363LP2300X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 10D2302842
LAB Type Practitioner Other
Facility Name TUPELO PRIMARY CARE
Street 412 N HWY 71
City WEWAHITCHKA
State FL
ZIP 32465
Phone 850 639-4036
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/17/2024
Certificate Expiration Date 4/16/2026
Facility Type Practitioner Other
Lab Director AMY L. MILLER

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