Provider Demographics
NPI:1043578420
Name:WYNNHALL, LATANYA FAYE
Entity Type:Individual
Prefix:MRS
First Name:LATANYA
Middle Name:FAYE
Last Name:WYNNHALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1485 S SEMORAN BLVD STE 1448
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-5508
Mailing Address - Country:US
Mailing Address - Phone:321-397-3000
Mailing Address - Fax:
Practice Address - Street 1:605 NE 1ST ST STE C
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-3318
Practice Address - Country:US
Practice Address - Phone:352-334-0955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker