Provider Demographics
NPI:1649259326
Name:POSEY, LATEESA THAMANI (APRN)
Entity type:Individual
Prefix:MS
First Name:LATEESA
Middle Name:THAMANI
Last Name:POSEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7715 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-3439
Mailing Address - Country:US
Mailing Address - Phone:718-833-2300
Mailing Address - Fax:718-836-2305
Practice Address - Street 1:7715 4TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3439
Practice Address - Country:US
Practice Address - Phone:718-833-2300
Practice Address - Fax:718-836-2305
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY382299363LP0200X
TN7996363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1505756Medicaid
TNQ28164Medicare UPIN
TN3649158Medicare PIN