Provider Demographics
NPI:1912558602
Name:ROBERTS, STARLEEKA LATASHA (RN)
Entity Type:Individual
Prefix:MS
First Name:STARLEEKA
Middle Name:LATASHA
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:STARLEEKA
Other - Middle Name:LATASHA
Other - Last Name:CREQUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3255 LAKECREST RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-4909
Mailing Address - Country:US
Mailing Address - Phone:757-581-7976
Mailing Address - Fax:
Practice Address - Street 1:3636 HIGH ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-3236
Practice Address - Country:US
Practice Address - Phone:757-398-4857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-24
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001223408163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse