Provider Demographics
NPI:1467915850
Name:YOUNG, CAMESHA LATRAVIA
Entity Type:Individual
Prefix:
First Name:CAMESHA
Middle Name:LATRAVIA
Last Name:YOUNG
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 1:3313 ARMSTRONG CT
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-4560
Mailing Address - Country:US
Mailing Address - Phone:239-200-0344
Mailing Address - Fax:
Practice Address - Street 1:3313 ARMSTRONG CT
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33916-4560
Practice Address - Country:US
Practice Address - Phone:239-200-0344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-11
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide