Provider Demographics
NPI:1790983955
Name:DICKENS-JONES, LATOYA NICOLE (DNP, APRN, FNP, ACNP)
Entity Type:Individual
Prefix:MRS
First Name:LATOYA
Middle Name:NICOLE
Last Name:DICKENS-JONES
Suffix:
Gender:F
Credentials:DNP, APRN, FNP, ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2235 TIMES AVE SW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44706-2115
Mailing Address - Country:US
Mailing Address - Phone:330-477-2415
Mailing Address - Fax:
Practice Address - Street 1:2725 LINCOLN ST E
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44707-2769
Practice Address - Country:US
Practice Address - Phone:330-454-2000
Practice Address - Fax:330-809-6390
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP09292363L00000X
OHNP 09292363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2820577Medicaid
OH2820577Medicaid