Provider Demographics
NPI:1588214209
Name:NEALY, LATOYA NICOLE
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:NICOLE
Last Name:NEALY
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 1:890 INDEPENDENT ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:FL
Mailing Address - Zip Code:32344-1510
Mailing Address - Country:US
Mailing Address - Phone:850-354-4644
Mailing Address - Fax:
Practice Address - Street 1:890 INDEPENDENT ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:FL
Practice Address - Zip Code:32344-1510
Practice Address - Country:US
Practice Address - Phone:850-321-9363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-14
Last Update Date:2021-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemaker