Healthcare Provider Details

I. General information

NPI: 1629590468
Provider Name (Legal Business Name): LATISHA PLANTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2017
Last Update Date: 07/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12789 SW 38TH CIR
OCALA FL
34473
US

IV. Provider business mailing address

12789 SW 38TH CIR
OCALA FL
34473-7801
US

V. Phone/Fax

Practice location:
  • Phone: 352-415-5615
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: