Healthcare Provider Details

I. General information

NPI: 1922621432
Provider Name (Legal Business Name): LATASHA TRACY WARREN DNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2020
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 S BROADWAY # 200-357
DENVER CO
80209-1558
US

IV. Provider business mailing address

10000 FANNIN ST APT 110
HOUSTON TX
77045-4662
US

V. Phone/Fax

Practice location:
  • Phone: 720-897-3749
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95014514
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: