Provider Demographics
NPI:1407925910
Name:LATHAM, ROSEMARIE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:ROSEMARIE
Middle Name:
Last Name:LATHAM
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 S VOLUSIA AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-9134
Mailing Address - Country:US
Mailing Address - Phone:386-774-0401
Mailing Address - Fax:386-774-5783
Practice Address - Street 1:2501 S VOLUSIA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-9134
Practice Address - Country:US
Practice Address - Phone:386-774-0401
Practice Address - Fax:386-774-5783
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1273642363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner