Provider Demographics
NPI:1295431344
Name:SMITH, LATONYA PATRICE (RN)
Entity type:Individual
Prefix:MRS
First Name:LATONYA
Middle Name:PATRICE
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1731 RIDGEMOOR DR
Mailing Address - Street 2:
Mailing Address - City:MASCOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:34753-9654
Mailing Address - Country:US
Mailing Address - Phone:321-331-5567
Mailing Address - Fax:
Practice Address - Street 1:1731 RIDGEMOOR DR
Practice Address - Street 2:
Practice Address - City:MASCOTTE
Practice Address - State:FL
Practice Address - Zip Code:34753-9654
Practice Address - Country:US
Practice Address - Phone:321-331-5567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-31
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
376J00000X
FLRN9345041163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No376J00000XNursing Service Related ProvidersHomemaker