Provider Demographics
NPI:1609422724
Name:ANTOINE, LATERICA LASHA (FNP)
Entity Type:Individual
Prefix:
First Name:LATERICA
Middle Name:LASHA
Last Name:ANTOINE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LATERICA
Other - Middle Name:LASHA
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:441 HEYMANN BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2611
Mailing Address - Country:US
Mailing Address - Phone:337-289-8429
Mailing Address - Fax:337-289-8431
Practice Address - Street 1:441 HEYMANN BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2611
Practice Address - Country:US
Practice Address - Phone:337-289-8429
Practice Address - Fax:337-289-8431
Is Sole Proprietor?:No
Enumeration Date:2019-08-14
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA206958363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily