Provider Demographics
NPI:1932721594
Name:GRAHAM, LATOYA (RN)
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LATOYA
Other - Middle Name:LATISH
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:8544 PINEVERDE LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-5258
Mailing Address - Country:US
Mailing Address - Phone:347-351-1826
Mailing Address - Fax:
Practice Address - Street 1:8544 PINEVERDE LN
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-5258
Practice Address - Country:US
Practice Address - Phone:347-351-1826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-17
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9526227163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health