Provider Demographics
NPI:1215572383
Name:CAMPBELL, LATOYA ANNTOINETTE
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:ANNTOINETTE
Last Name:CAMPBELL
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 1:15485 SW 288TH ST APT C305
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-1332
Mailing Address - Country:US
Mailing Address - Phone:786-343-2309
Mailing Address - Fax:
Practice Address - Street 1:15485 SW 288TH ST BLDG C305
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-1372
Practice Address - Country:US
Practice Address - Phone:786-343-2309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-13
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide