Provider Demographics
NPI:1558781906
Name:LATTIBEAUDIERE, TONI PATRICIA (APRN)
Entity type:Individual
Prefix:
First Name:TONI
Middle Name:PATRICIA
Last Name:LATTIBEAUDIERE
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11801 TRAILRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-2835
Mailing Address - Country:US
Mailing Address - Phone:954-487-9057
Mailing Address - Fax:954-337-0302
Practice Address - Street 1:11801 TRAILRIDGE DR
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-2835
Practice Address - Country:US
Practice Address - Phone:954-487-9057
Practice Address - Fax:954-337-0302
Is Sole Proprietor?:No
Enumeration Date:2014-04-24
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9170276163WD0400X, 363LA2200X
DCNP500014800363LF0000X
NYF356158-01363LF0000X
MDR262100363LF0000X
VA0024188220363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023499300Medicaid