Healthcare Provider Details

I. General information

NPI: 1063436160
Provider Name (Legal Business Name): LATAMIA M WHITE-GREEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LATAMIA M WHITE MD

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 02/27/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12410 N NEBRASKA AVE
TAMPA FL
33612-5352
US

IV. Provider business mailing address

PO BOX 82969
TAMPA FL
33682-2969
US

V. Phone/Fax

Practice location:
  • Phone: 813-397-5300
  • Fax: 813-865-0158
Mailing address:
  • Phone: 813-866-0930
  • Fax: 813-405-3722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME-93569
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: