Provider Demographics
NPI:1720710122
Name:HART, LATRINA M (CNA/ MEDICATION AIDE)
Entity Type:Individual
Prefix:
First Name:LATRINA
Middle Name:M
Last Name:HART
Suffix:
Gender:F
Credentials:CNA/ MEDICATION AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25316 FORD AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH DINWIDDIE
Mailing Address - State:VA
Mailing Address - Zip Code:23803-8918
Mailing Address - Country:US
Mailing Address - Phone:804-503-4857
Mailing Address - Fax:
Practice Address - Street 1:25316 FORD AVE
Practice Address - Street 2:
Practice Address - City:NORTH DINWIDDIE
Practice Address - State:VA
Practice Address - Zip Code:23803-8918
Practice Address - Country:US
Practice Address - Phone:804-503-4857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-26
Last Update Date:2022-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1401074354376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty