Provider Demographics
NPI:1235744525
Name:COOK, LATOYA SHANTAE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:LATOYA
Middle Name:SHANTAE
Last Name:COOK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 442
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38088-0442
Mailing Address - Country:US
Mailing Address - Phone:901-949-9916
Mailing Address - Fax:
Practice Address - Street 1:1900 KIRBY PKWY STE 203
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3649
Practice Address - Country:US
Practice Address - Phone:901-676-6218
Practice Address - Fax:901-425-9639
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-13
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN203618163WG0000X
TN28319363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice