Healthcare Provider Details

I. General information

NPI: 1316137599
Provider Name (Legal Business Name): LATANYA EARNEST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 07/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1485 INTERNATIONAL PKWY STE 2051
HEATHROW FL
32746-5352
US

IV. Provider business mailing address

749 CLINTON AVE
SIDNEY OH
45365-2111
US

V. Phone/Fax

Practice location:
  • Phone: 800-798-6035
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number03714
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: