Healthcare Provider Details

I. General information

NPI: 1558781906
Provider Name (Legal Business Name): TONI PATRICIA LATTIBEAUDIERE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2014
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11801 TRAILRIDGE DR
POTOMAC MD
20854-2835
US

IV. Provider business mailing address

11801 TRAILRIDGE DR
POTOMAC MD
20854-2835
US

V. Phone/Fax

Practice location:
  • Phone: 954-487-9057
  • Fax: 954-337-0302
Mailing address:
  • Phone: 954-487-9057
  • Fax: 954-337-0302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberARNP9170276
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP500014800
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF356158-01
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR262100
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024188220
License Number StateVA
# 6
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP9170276
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: