Provider Demographics
NPI:1952951550
Name:MOORE, LATAIYA
Entity Type:Individual
Prefix:MRS
First Name:LATAIYA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 AVENUE Q
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34947-5600
Mailing Address - Country:US
Mailing Address - Phone:772-209-2825
Mailing Address - Fax:
Practice Address - Street 1:3801 AVENUE Q
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34947-5600
Practice Address - Country:US
Practice Address - Phone:772-209-2825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-16
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No376K00000XNursing Service Related ProvidersNurse's Aide