MEDICARE: LABORATORY OF FLORIDA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory		FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407113020
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LABORATORY OF FLORIDA LLC

Provider Business Mailing Address
First Line	:	7520 W WATERS AVE STE 4
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-1599
Country	:	US
Telephone Number	:	813-885-7755
Fax Number	:	813-885-6688

Provider Business Practice Location Address
First Line	:	7520 W WATERS AVE STE 4
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-1599
Country	:	US
Telephone Number	:	813-885-7755
Fax Number	:	813-885-6688

Authorized Official
Title or Position	:	CEO
Name	:	MR. ANDREI LEONOV
Credential	:
Telephone Number	:	813-885-7755

Provider Enumeration Date	:	04/19/2012
Last Update Date	:	09/04/2025

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