Provider Demographics
NPI:1619718087
Name:PATRIOT LABORATORY LLC
Entity type:Organization
Organization Name:PATRIOT LABORATORY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:REGINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-446-6556
Mailing Address - Street 1:3705 S HWY 27
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-7950
Mailing Address - Country:US
Mailing Address - Phone:407-446-6556
Mailing Address - Fax:888-304-2622
Practice Address - Street 1:2380 SUNSET POINT RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-1430
Practice Address - Country:US
Practice Address - Phone:727-466-1028
Practice Address - Fax:727-232-9779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-01
Last Update Date:2025-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory