Provider Demographics
NPI:1982643672
Name:LATOURETTE, CARLA LESLIE (PA-C)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:LESLIE
Last Name:LATOURETTE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 SOUTH TAMIAMI TRAIL
Mailing Address - Street 2:STE 401
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239
Mailing Address - Country:US
Mailing Address - Phone:941-917-0060
Mailing Address - Fax:941-316-9305
Practice Address - Street 1:1540 SOUTH TAMIAMI TRAIL
Practice Address - Street 2:SUITE 401
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239
Practice Address - Country:US
Practice Address - Phone:941-917-0060
Practice Address - Fax:941-316-9305
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9116286363A00000X
ARPA-145363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P88945Medicare UPIN