Provider Demographics
NPI:1285821017
Name:AMICK, LATINA GRIGGS (MSN, CNP, RN-BC)
Entity Type:Individual
Prefix:MRS
First Name:LATINA
Middle Name:GRIGGS
Last Name:AMICK
Suffix:
Gender:F
Credentials:MSN, CNP, RN-BC
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Mailing Address - Street 1:2109 HUGHES DR
Mailing Address - Street 2:CONRAD JOBST TOWER, SUITE 420
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3856
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2109 HUGHES DR
Practice Address - Street 2:CONRAD JOBST TOWER, SUITE 420
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3856
Practice Address - Country:US
Practice Address - Phone:419-291-4000
Practice Address - Fax:419-480-8715
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704228312363L00000X
OHNP-07840363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3037225Medicaid
OH3037225Medicaid