Provider Demographics
NPI:1922393172
Name:PATILLO-JONES, LATASHA D (FNP)
Entity Type:Individual
Prefix:MRS
First Name:LATASHA
Middle Name:D
Last Name:PATILLO-JONES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7691 POPLAR AVE STE 3084
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3904
Mailing Address - Country:US
Mailing Address - Phone:901-237-8703
Mailing Address - Fax:901-516-6385
Practice Address - Street 1:7691 POPLAR AVE STE 3084
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3904
Practice Address - Country:US
Practice Address - Phone:901-237-8703
Practice Address - Fax:901-516-6385
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000015731363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily