Provider Demographics
NPI:1376162586
Name:FREEMAN, LATOYA (AG-ACNP)
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:AG-ACNP
Other - Prefix:
Other - First Name:LA TOYA
Other - Middle Name:
Other - Last Name:CARLISLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PSC 78 BOX 1875
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96326-0019
Mailing Address - Country:US
Mailing Address - Phone:623-734-9620
Mailing Address - Fax:
Practice Address - Street 1:374TH MEDICAL GROUP
Practice Address - Street 2:BUILDING #4408
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96328
Practice Address - Country:US
Practice Address - Phone:623-734-9620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM57502363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care