Provider Demographics
NPI:1780474924
Name:SIMS, LATASHA
Entity type:Individual
Prefix:MRS
First Name:LATASHA
Middle Name:
Last Name:SIMS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 CHERRY LAUREL DR
Mailing Address - Street 2:
Mailing Address - City:HAZEL GREEN
Mailing Address - State:AL
Mailing Address - Zip Code:35750-4301
Mailing Address - Country:US
Mailing Address - Phone:334-322-2621
Mailing Address - Fax:
Practice Address - Street 1:115 SAINT CLAIR AVE SE STE 200
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4344
Practice Address - Country:US
Practice Address - Phone:256-519-3650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-10
Last Update Date:2025-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-151246363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily