Provider Demographics
NPI:1457902264
Name:AUSTIN, LETITIA MONISE
Entity Type:Individual
Prefix:
First Name:LETITIA
Middle Name:MONISE
Last Name:AUSTIN
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 1:511 NW 7TH CT APT B
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-2270
Mailing Address - Country:US
Mailing Address - Phone:786-346-9467
Mailing Address - Fax:
Practice Address - Street 1:511 NW 7TH CT APT B
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-2270
Practice Address - Country:US
Practice Address - Phone:786-346-9467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No372600000XNursing Service Related ProvidersAdult Companion