Healthcare Provider Details

I. General information

NPI: 1366013260
Provider Name (Legal Business Name): LATANDREA RUFFINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2021
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7505 PINES ROAD SUITE 1200-E
SHREVEPORT LA
71129-3935
US

IV. Provider business mailing address

7505 PINES ROAD SUITE 1200-E
SHREVEPORT LA
71129-3935
US

V. Phone/Fax

Practice location:
  • Phone: 318-517-7428
  • Fax: 318-568-8019
Mailing address:
  • Phone: 318-517-7428
  • Fax: 318-568-8019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number339805
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: