Healthcare Provider Details

I. General information

NPI: 1023616778
Provider Name (Legal Business Name): LATOYA TANIQUE SINCLAIR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2020
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6804 CECELIA DR
NEW PORT RICHEY FL
34653-4935
US

IV. Provider business mailing address

1625 LADY SLIPPER CIR
ORLANDO FL
32825-8812
US

V. Phone/Fax

Practice location:
  • Phone: 855-232-0644
  • Fax: 888-546-0488
Mailing address:
  • Phone: 832-807-1319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11009686
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number11009686
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: