Healthcare Provider Details

I. General information

NPI: 1417373804
Provider Name (Legal Business Name): LATOYA LOVELESS-KNOX CERTIFIED HAIR LOSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2014
Last Update Date: 03/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2161 PALO ALTO ST
NAVARRE FL
32566-1210
US

IV. Provider business mailing address

2161 PALO ALTO ST
NAVARRE FL
32566-1210
US

V. Phone/Fax

Practice location:
  • Phone: 850-736-7061
  • Fax:
Mailing address:
  • Phone: 850-736-7061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: