Provider Demographics
NPI:1417613845
Name:HART, LATASHA RENEE (PMHNP)
Entity Type:Individual
Prefix:MRS
First Name:LATASHA
Middle Name:RENEE
Last Name:HART
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:MS
Other - First Name:LATASHA
Other - Middle Name:RENEE
Other - Last Name:HART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP
Mailing Address - Street 1:214 OLIVE AVE
Mailing Address - Street 2:
Mailing Address - City:POMPTON LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07442-1550
Mailing Address - Country:US
Mailing Address - Phone:954-864-0794
Mailing Address - Fax:
Practice Address - Street 1:2 WALNUT STREET
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901
Practice Address - Country:US
Practice Address - Phone:888-247-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-10
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01153300363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health