Provider Demographics
NPI:1477181170
Name:LATSON, PAMELA (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:LATSON
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 FEATHER SOUND DR,UNIT 427
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33762
Mailing Address - Country:US
Mailing Address - Phone:919-805-2075
Mailing Address - Fax:
Practice Address - Street 1:2400 FEATHER SOUND DR,UNIT 427
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33762-3376
Practice Address - Country:US
Practice Address - Phone:919-805-2075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-29
Last Update Date:2020-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND5966133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered