Provider Demographics
NPI:1740264175
Name:HAYNES, LATOYA MONIQUE (PA-C)
Entity type:Individual
Prefix:DR
First Name:LATOYA
Middle Name:MONIQUE
Last Name:HAYNES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LATOYA
Other - Middle Name:MONIQUE
Other - Last Name:SAWYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C, DHSC
Mailing Address - Street 1:9300 DEWITT LOOP
Mailing Address - Street 2:
Mailing Address - City:FORT BELVOIR
Mailing Address - State:VA
Mailing Address - Zip Code:22060-5285
Mailing Address - Country:US
Mailing Address - Phone:571-231-2191
Mailing Address - Fax:571-231-2242
Practice Address - Street 1:9300 DEWITT LOOP
Practice Address - Street 2:
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060-5285
Practice Address - Country:US
Practice Address - Phone:571-231-2191
Practice Address - Fax:571-231-2242
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-03102363A00000X
GA003562363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant