10D2319464 CLIA NUMBER - LATITUDE CLINIC LLC

Laboratory Demographics

  • CLIA Code: 10D2319464
  • Facility Name: LATITUDE CLINIC LLC
  • Facility Address: 2400 HARBOR BLVD UNIT 18
    PORT CHARLOTTE, FL
    ZIP 33952
  • Facility Phone: 941 253-2530
  • Facility Type: Other - APRN
  • Facility Type: Waiver
  • Lab Director: VANESSA HAMALIAN
  • NPI Number: 1598345654
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 10D2319464
LAB Type Other - APRN
Facility Name LATITUDE CLINIC LLC
Street 2400 HARBOR BLVD UNIT 18
City PORT CHARLOTTE
State FL
ZIP 33952
Phone 941 253-2530
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/28/2025
Certificate Expiration Date 2/27/2027
Facility Type Other - APRN
Lab Director VANESSA HAMALIAN

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