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General NPI Number Information
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NPI Number | 1598345654
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Entity Type | Organization
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Legal Business Name | LATITUDE CLINIC LLC
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Dates
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Enumeration Date | 04/13/2021
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Last Update Date | 04/13/2021
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Provider Practice Location Address
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Address Line | 2831 RINGLING BLVD STE 220F
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City | SARASOTA
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State | FL
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Zip | 34237-5354
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Country | US
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Telephone | 941-253-2530
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Fax | 941-303-8619
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Provider Business Mailing Address
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Address Line | 2831 RINGLING BLVD STE 220F
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City | SARASOTA
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State | FL
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Zip | 34237-5354
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Country | US
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Telephone | 941-253-2530
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Fax | 941-303-8619
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Authorized Official
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Title or Position | OWNER
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Name | VANESSA HAMALIAN
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Credential | APRN
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Telephone | 941-544-4922
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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