Provider Demographics
NPI:1700056033
Name:CARROLL, LATONYA JANETT (DNP, APRNCNP)
Entity Type:Individual
Prefix:DR
First Name:LATONYA
Middle Name:JANETT
Last Name:CARROLL
Suffix:
Gender:F
Credentials:DNP, APRNCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1391 W 5TH AVE # 241
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-2902
Mailing Address - Country:US
Mailing Address - Phone:877-318-0934
Mailing Address - Fax:888-831-0965
Practice Address - Street 1:655 N CASSADY AVE STE 7
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-2720
Practice Address - Country:US
Practice Address - Phone:410-569-8940
Practice Address - Fax:614-375-4130
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8581207QA0401X
IL2777000957207QA0401X
VA0024178144207QA0401X
WV104979207QA0401X
NH081831-23207QA0401X
CO0001166207QA0401X
NY344401207QA0401X
MN5573207QA0401X
NV820843207QA0401X
RIAPRN02420207QA0401X
IAA159261207QA0401X
NMTEMP60444207QA0401X
MECNP171188207QA0401X
OH13287207QA0401X
MDAC002387363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0100318Medicaid
MD222585900Medicaid