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General NPI Number Information
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NPI Number | 1376123851
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Entity Type | Individual
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Provider Name | LATRICE ANTRAE LOUIS
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Gender | Female
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Dates
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Enumeration Date | 04/09/2021
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Last Update Date | 04/09/2021
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Provider Practice Location Address
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Address Line | 919 NORTH 25TH STREET 6-101
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City | FORT PIERCE
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State | FL
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Zip | 34950
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Country | US
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Telephone | 772-882-2705
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Fax |
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Provider Business Mailing Address
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Address Line | 913 NW 12TH ST
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City | OKEECHOBEE
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State | FL
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Zip | 34972-2041
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Country | US
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Telephone | 772-519-4201
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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 | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number |
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License Number State |
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