Healthcare Provider Details

I. General information

NPI: 1942892609
Provider Name (Legal Business Name): LATOYA RENEE NTLABATI PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2021
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11828 CANON BLVD STE H
NEWPORT NEWS VA
23606-2554
US

IV. Provider business mailing address

276 PATRICKS XING
WILLIAMSBURG VA
23185-2606
US

V. Phone/Fax

Practice location:
  • Phone: 804-933-6500
  • Fax: 804-793-9173
Mailing address:
  • Phone: 313-759-6717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024180764
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: