Healthcare Provider Details

I. General information

NPI: 1578954830
Provider Name (Legal Business Name): LATOYA POLANCO ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2015
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 S ANDREWS AVE FL 3
FORT LAUDERDALE FL
33316-2509
US

IV. Provider business mailing address

1608 SE 3RD AVE FL 3
FORT LAUDERDALE FL
33316-2564
US

V. Phone/Fax

Practice location:
  • Phone: 954-320-3304
  • Fax: 954-320-3318
Mailing address:
  • Phone: 954-302-3304
  • Fax: 954-320-3318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9313336
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: