Provider Demographics
NPI:1740653617
Name:WHITE, LATOYA RENEE (CNA)
Entity type:Individual
Prefix:MRS
First Name:LATOYA
Middle Name:RENEE
Last Name:WHITE
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 GEORGIA AVE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-3707
Mailing Address - Country:US
Mailing Address - Phone:352-409-7958
Mailing Address - Fax:
Practice Address - Street 1:1009 GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-3707
Practice Address - Country:US
Practice Address - Phone:352-409-7958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL304813376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015924500Medicaid