Provider Demographics
NPI:1508217670
Name:SPEARS, LATASHA T
Entity Type:Individual
Prefix:
First Name:LATASHA
Middle Name:T
Last Name:SPEARS
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 1:785 HOMESTEAD RD S
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33974-7651
Mailing Address - Country:US
Mailing Address - Phone:239-745-9012
Mailing Address - Fax:
Practice Address - Street 1:785 HOMESTEAD RD S
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33974-7651
Practice Address - Country:US
Practice Address - Phone:239-745-9012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL311446374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide