Healthcare Provider Details

I. General information

NPI: 1154862746
Provider Name (Legal Business Name): LATASHA HOTT NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2017
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 ST. MATTHEWS RD
ORANGEBURG SC
29118
US

IV. Provider business mailing address

2323 SAINT MATTHEWS RD
ORANGEBURG SC
29118-2042
US

V. Phone/Fax

Practice location:
  • Phone: 803-310-5994
  • Fax: 803-219-8954
Mailing address:
  • Phone: 803-310-5994
  • Fax: 803-219-8954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number20663
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number20663
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number20663
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: