Healthcare Provider Details

I. General information

NPI: 1760302376
Provider Name (Legal Business Name): LATOSCHA DEWAYNA EDWARDS-SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

728 FENTRESS BLVD
DAYTONA BEACH FL
32114-1214
US

IV. Provider business mailing address

728 FENTRESS BLVD
DAYTONA BEACH FL
32114-1214
US

V. Phone/Fax

Practice location:
  • Phone: 423-255-9908
  • Fax:
Mailing address:
  • Phone: 423-255-9908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: