Provider Demographics
NPI:1740838572
Name:WEST, LAQUISTA
Entity type:Individual
Prefix:
First Name:LAQUISTA
Middle Name:
Last Name:WEST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 S FRENCH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MEADE
Mailing Address - State:FL
Mailing Address - Zip Code:33841-3914
Mailing Address - Country:US
Mailing Address - Phone:863-440-8294
Mailing Address - Fax:
Practice Address - Street 1:4250 US HIGHWAY 17 N
Practice Address - Street 2:
Practice Address - City:FORT MEADE
Practice Address - State:FL
Practice Address - Zip Code:33841-8606
Practice Address - Country:US
Practice Address - Phone:863-440-8294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health