Provider Demographics
NPI:1235473638
Name:LYNCH, LATISA TIANA (ARNP)
Entity Type:Individual
Prefix:
First Name:LATISA
Middle Name:TIANA
Last Name:LYNCH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:LATISA
Other - Middle Name:TIANA
Other - Last Name:HINES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 82969
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33682-2969
Mailing Address - Country:US
Mailing Address - Phone:813-866-0930
Mailing Address - Fax:813-866-0929
Practice Address - Street 1:4620 N 22ND ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-6205
Practice Address - Country:US
Practice Address - Phone:813-272-6240
Practice Address - Fax:813-866-0929
Is Sole Proprietor?:No
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9270159363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily