Healthcare Provider Details

I. General information

NPI: 1932721594
Provider Name (Legal Business Name): LATOYA GRAHAM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LATOYA LATISH GRAHAM RN

II. Dates (important events)

Enumeration Date: 05/17/2020
Last Update Date: 05/26/2020
Certification Date: 05/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8544 PINEVERDE LN
JACKSONVILLE FL
32244-5258
US

IV. Provider business mailing address

8544 PINEVERDE LN
JACKSONVILLE FL
32244-5258
US

V. Phone/Fax

Practice location:
  • Phone: 347-351-1826
  • Fax:
Mailing address:
  • Phone: 347-351-1826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN9526227
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: