Provider Demographics
NPI:1134356892
Name:BLAKEMORE, LATRINA NOVELLE (FNP)
Entity type:Individual
Prefix:
First Name:LATRINA
Middle Name:NOVELLE
Last Name:BLAKEMORE
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 1:1509 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-3726
Mailing Address - Country:US
Mailing Address - Phone:901-272-0806
Mailing Address - Fax:901-729-2428
Practice Address - Street 1:1509 UNION AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3726
Practice Address - Country:US
Practice Address - Phone:901-272-0806
Practice Address - Fax:901-729-2428
Is Sole Proprietor?:No
Enumeration Date:2009-06-19
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000014207363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily