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General NPI Number Information
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NPI Number | 1619718087
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Entity Type | Organization
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Legal Business Name | PATRIOT LABORATORY LLC
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Dates
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Enumeration Date | 06/01/2024
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Last Update Date | 11/20/2025
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Provider Practice Location Address
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Address Line | 2380 SUNSET POINT RD
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City | CLEARWATER
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State | FL
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Zip | 33765-1430
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Country | US
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Telephone | 727-466-1028
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Fax | 727-232-9779
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Provider Business Mailing Address
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Address Line | 3705 S HWY 27
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City | CLERMONT
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State | FL
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Zip | 34711-7950
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Country | US
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Telephone | 407-446-6556
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Fax | 888-304-2622
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Authorized Official
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Title or Position | COO
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Name | VICKI REGINA
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Credential |
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Telephone | 407-446-6556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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