Provider Demographics
NPI:1376123851
Name:LOUIS, LATRICE ANTRAE
Entity Type:Individual
Prefix:
First Name:LATRICE
Middle Name:ANTRAE
Last Name:LOUIS
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 1:913 NW 12TH ST
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34972-2041
Mailing Address - Country:US
Mailing Address - Phone:772-519-4201
Mailing Address - Fax:
Practice Address - Street 1:919 NORTH 25TH STREET
Practice Address - Street 2:6-101
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950
Practice Address - Country:US
Practice Address - Phone:772-882-2705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide