Provider Demographics
NPI:1982118253
Name:EDMEADE, LATUANA SADIQUA
Entity Type:Individual
Prefix:
First Name:LATUANA
Middle Name:SADIQUA
Last Name:EDMEADE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LATUANA
Other - Middle Name:SADIQUA
Other - Last Name:RUSHIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:48 SELMA TRL
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-5447
Mailing Address - Country:US
Mailing Address - Phone:386-569-3525
Mailing Address - Fax:
Practice Address - Street 1:48 SELMA TRL
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-5447
Practice Address - Country:US
Practice Address - Phone:386-569-3525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-25
Last Update Date:2017-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006282800Medicaid