Provider Demographics
NPI:1740640309
Name:PIERCE, LATIA M (APN)
Entity type:Individual
Prefix:
First Name:LATIA
Middle Name:M
Last Name:PIERCE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:LATIA
Other - Middle Name:M
Other - Last Name:COLVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1279 TAMMIE TER
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-5521
Mailing Address - Country:US
Mailing Address - Phone:856-899-7772
Mailing Address - Fax:
Practice Address - Street 1:1279 TAMMIE TER
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-5521
Practice Address - Country:US
Practice Address - Phone:609-888-6915
Practice Address - Fax:856-249-9573
Is Sole Proprietor?:No
Enumeration Date:2016-02-25
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR17683300163WG0000X
NJ26NJ00620600363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0506559Medicaid