Provider Demographics
NPI:1760159826
Name:BOSTIC, LATOYA DIONNE (PMHNP-BC)
Entity Type:Individual
Prefix:MISS
First Name:LATOYA
Middle Name:DIONNE
Last Name:BOSTIC
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 SPRINGFIELD PIKE APT 23
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-2154
Mailing Address - Country:US
Mailing Address - Phone:513-570-1231
Mailing Address - Fax:
Practice Address - Street 1:1410 SPRINGFIELD PIKE APT 23
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45215-2154
Practice Address - Country:US
Practice Address - Phone:513-570-1231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0029229363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health