Provider Demographics
NPI:1578954830
Name:POLANCO, LATOYA (ARNP)
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:
Last Name:POLANCO
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 1:7150 W 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5529
Mailing Address - Country:US
Mailing Address - Phone:058-206-6573
Mailing Address - Fax:305-820-6550
Practice Address - Street 1:7150 W 20TH AVE
Practice Address - Street 2:STE 615
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-5529
Practice Address - Country:US
Practice Address - Phone:305-820-6657
Practice Address - Fax:305-820-6658
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-09
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9313336363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily