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General NPI Number Information
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NPI Number | 1346150919
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Entity Type | Individual
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Provider Name | MADELYN LATTYAK PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/08/2026
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Last Update Date | 09/08/2026
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Provider Practice Location Address
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Address Line | 1801 N JACKSON ST STE 100A
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City | TULLAHOMA
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State | TN
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Zip | 37388-8259
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Country | US
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Telephone | 931-393-7831
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Fax |
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Provider Business Mailing Address
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Address Line | 121 BURLCREST CT
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City | MERIDIANVILLE
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State | AL
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Zip | 35759-1669
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Country | US
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Telephone | 724-977-4745
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State | TN
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