Provider Demographics
NPI:1811521321
Name:CRAIG-GLENN, LATAYNA (NP)
Entity type:Individual
Prefix:MRS
First Name:LATAYNA
Middle Name:
Last Name:CRAIG-GLENN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LATAYNA
Other - Middle Name:
Other - Last Name:CRAIG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:216 FARM SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:MT HOLLY
Mailing Address - State:NC
Mailing Address - Zip Code:28120-8431
Mailing Address - Country:US
Mailing Address - Phone:704-685-4652
Mailing Address - Fax:
Practice Address - Street 1:216 FARM SPRINGS DR
Practice Address - Street 2:
Practice Address - City:MT HOLLY
Practice Address - State:NC
Practice Address - Zip Code:28120-8431
Practice Address - Country:US
Practice Address - Phone:704-685-4652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCRAI-28KXPO363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily