Provider Demographics
NPI:1164931143
Name:LATOUCHE, MARIE B (NP-C)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:B
Last Name:LATOUCHE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 NW 49TH ST STE 125
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3750
Mailing Address - Country:US
Mailing Address - Phone:954-933-9600
Mailing Address - Fax:954-781-9828
Practice Address - Street 1:3896 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:LIGHTHOUSE POINT
Practice Address - State:FL
Practice Address - Zip Code:33064-6612
Practice Address - Country:US
Practice Address - Phone:954-933-9600
Practice Address - Fax:954-781-9828
Is Sole Proprietor?:No
Enumeration Date:2017-09-22
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9191134363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology