Provider Demographics
NPI:1083302947
Name:BELLAMY, LATASHA
Entity Type:Individual
Prefix:MRS
First Name:LATASHA
Middle Name:
Last Name:BELLAMY
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 1:4452 LOVETT RD
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32448-5019
Mailing Address - Country:US
Mailing Address - Phone:850-372-2047
Mailing Address - Fax:
Practice Address - Street 1:4452 LOVETT RD
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32448-5019
Practice Address - Country:US
Practice Address - Phone:850-372-2047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion