Healthcare Provider Details

I. General information

NPI: 1699931857
Provider Name (Legal Business Name): LATASHA M SEAL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LATASHA JARNAGIN

II. Dates (important events)

Enumeration Date: 08/06/2008
Last Update Date: 09/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1179 HIGHWAY 11W
BEAN STATION TN
37708-5809
US

IV. Provider business mailing address

1179 HIGHWAY 11W
BEAN STATION TN
37708-5809
US

V. Phone/Fax

Practice location:
  • Phone: 865-993-1070
  • Fax: 865-993-1075
Mailing address:
  • Phone: 865-993-1070
  • Fax: 865-993-1075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number13557
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: