Provider Demographics
NPI:1225693559
Name:SWEET, LATASHA SHAMANE
Entity Type:Individual
Prefix:
First Name:LATASHA
Middle Name:SHAMANE
Last Name:SWEET
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 1:10 HEMLOCK TERRACE RUN
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34472-6271
Mailing Address - Country:US
Mailing Address - Phone:352-816-6740
Mailing Address - Fax:
Practice Address - Street 1:10 HEMLOCK TERRACE RUN
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34472-6271
Practice Address - Country:US
Practice Address - Phone:352-816-6740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-02
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS300537838681OtherDRIVERS LICENSE