Provider Demographics
NPI:1841300662
Name:LATIMER, YVONNE OLUBUMNI (MD)
Entity type:Individual
Prefix:DR
First Name:YVONNE
Middle Name:OLUBUMNI
Last Name:LATIMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 W SWANN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4039
Mailing Address - Country:US
Mailing Address - Phone:813-874-5500
Mailing Address - Fax:813-874-5505
Practice Address - Street 1:2605 W SWANN AVE STE 100
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4039
Practice Address - Country:US
Practice Address - Phone:813-874-5500
Practice Address - Fax:813-874-5505
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07603900207Q00000X
FLME99950207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0015318Medicaid
NJ082616BASMedicare ID - Type Unspecified
NJ0015318Medicaid