Provider Demographics
NPI:1235429143
Name:FLANNEL, LATANJA
Entity Type:Individual
Prefix:MS
First Name:LATANJA
Middle Name:
Last Name:FLANNEL
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 1:810 W DOWNS CT
Mailing Address - Street 2:APT 102
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-3352
Mailing Address - Country:US
Mailing Address - Phone:727-290-7082
Mailing Address - Fax:
Practice Address - Street 1:810 W DOWNS CT
Practice Address - Street 2:APT 102
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-3352
Practice Address - Country:US
Practice Address - Phone:727-290-7082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA209536376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide