Provider Demographics
NPI:1659084788
Name:HOOSANG, LATOYA (CSCM)
Entity Type:Individual
Prefix:MRS
First Name:LATOYA
Middle Name:
Last Name:HOOSANG
Suffix:
Gender:F
Credentials:CSCM
Other - Prefix:MR
Other - First Name:FLOYD
Other - Middle Name:
Other - Last Name:HOOSANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CSCM
Mailing Address - Street 1:9160 FORUM CORPORATE PKWY STE 350
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33905-7808
Mailing Address - Country:US
Mailing Address - Phone:239-837-0545
Mailing Address - Fax:239-309-0925
Practice Address - Street 1:9160 FORUM CORPORATE PKWY STE 350
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-7808
Practice Address - Country:US
Practice Address - Phone:239-837-0545
Practice Address - Fax:239-309-0925
Is Sole Proprietor?:No
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL239019376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker