Provider Demographics
NPI:1326656646
Name:LATTIMORE, SANTINA N (HOME HEALTH AIDE)
Entity Type:Individual
Prefix:
First Name:SANTINA
Middle Name:N
Last Name:LATTIMORE
Suffix:
Gender:F
Credentials:HOME HEALTH AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 2ND ST NW APT 52
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-4941
Mailing Address - Country:US
Mailing Address - Phone:386-601-5194
Mailing Address - Fax:
Practice Address - Street 1:2401 2ND ST NW APT 52
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4941
Practice Address - Country:US
Practice Address - Phone:863-258-4817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-22
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide