Provider Demographics
NPI:1932643053
Name:DAVIS, LATIFAH
Entity Type:Individual
Prefix:MS
First Name:LATIFAH
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4787 WALDEN CIR APT G
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-7310
Mailing Address - Country:US
Mailing Address - Phone:786-350-5107
Mailing Address - Fax:
Practice Address - Street 1:4787 WALDEN CIR APT G
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-7310
Practice Address - Country:US
Practice Address - Phone:786-350-5107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-08
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3270681164W00000X
FLPN5216002164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse