Provider Demographics
NPI:1184248379
Name:BROWN, LATORIA SHANAE
Entity type:Individual
Prefix:
First Name:LATORIA
Middle Name:SHANAE
Last Name:BROWN
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 1:2221 NW 1ST AVE APT 24
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34475-9173
Mailing Address - Country:US
Mailing Address - Phone:352-973-5614
Mailing Address - Fax:
Practice Address - Street 1:2221 NW 1ST AVE APT 24
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34475-9173
Practice Address - Country:US
Practice Address - Phone:352-973-5614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-03
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker