Provider Demographics
NPI:1740996743
Name:BRUTON, LATANYA (LPN)
Entity type:Individual
Prefix:
First Name:LATANYA
Middle Name:
Last Name:BRUTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6901A N 9TH AVE # 566
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-6638
Mailing Address - Country:US
Mailing Address - Phone:850-417-1188
Mailing Address - Fax:
Practice Address - Street 1:20870 ISHERWOOD TER APT 300
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-7790
Practice Address - Country:US
Practice Address - Phone:850-382-6840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-24
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5172428164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse