10D2307919 CLIA NUMBER - IMPACT PRACTITIONER SERVICES LLC

Laboratory Demographics

  • CLIA Code: 10D2307919
  • Facility Name: IMPACT PRACTITIONER SERVICES LLC
  • Facility Address: 3307 N INDIAN RIVER DRIVE
    FORT PIERCE, FL
    ZIP 34946
  • Facility Phone: 772 295-7455
  • Facility Type: Mobile Laboratory
  • Facility Type: Waiver
  • Lab Director: KELLI L. KRAAZ
  • NPI Number: 1982457081
  • Taxonomy: 363LP2300X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 10D2307919
LAB Type Mobile Laboratory
Facility Name IMPACT PRACTITIONER SERVICES LLC
Street 3307 N INDIAN RIVER DRIVE
City FORT PIERCE
State FL
ZIP 34946
Phone 772 295-7455
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/17/2024
Certificate Expiration Date 7/16/2026
Facility Type Mobile Laboratory
Lab Director KELLI L. KRAAZ

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