Healthcare Provider Details

I. General information

NPI: 1427804582
Provider Name (Legal Business Name): LATOYA FITZGERALD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2024
Last Update Date: 04/29/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9423 BIG BEN CIR
INDIANAPOLIS IN
46235-2111
US

IV. Provider business mailing address

9423 BIG BEN CIR
INDIANAPOLIS IN
46235-2111
US

V. Phone/Fax

Practice location:
  • Phone: 765-757-9165
  • Fax:
Mailing address:
  • Phone: 765-757-9165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number230160071
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: