Healthcare Provider Details

I. General information

NPI: 1538559778
Provider Name (Legal Business Name): LATOYA VICTOR FNP, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2015
Last Update Date: 11/02/2020
Certification Date: 11/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8630 FENTON ST STE 1200
SILVER SPRING MD
20910-3808
US

IV. Provider business mailing address

8630 FENTON ST STE 1204
SILVER SPRING MD
20910-3808
US

V. Phone/Fax

Practice location:
  • Phone: 301-585-1250
  • Fax: 301-585-6289
Mailing address:
  • Phone: 301-340-7525
  • Fax: 301-495-0318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberR185965
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR185965
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: