Healthcare Provider Details

I. General information

NPI: 1669747952
Provider Name (Legal Business Name): LATASHA MARIE TURNER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2012
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 MAIN STREET 3RD FL, SUITE A
SPRINGFIELD MA
01107-1112
US

IV. Provider business mailing address

280 CHESTNUT STREET 2ND FLOOR
SPRINGFIELD MA
01199-1001
US

V. Phone/Fax

Practice location:
  • Phone: 413-794-7031
  • Fax: 413-794-7133
Mailing address:
  • Phone: 413-794-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA6125
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: