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General NPI Number Information
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NPI Number | 1710411822
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Entity Type | Individual
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Provider Name | LATOSCA BRUNNER AGAC-NP
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Gender | Female
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Dates
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Enumeration Date | 04/14/2017
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Last Update Date | 10/03/2025
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Provider Practice Location Address
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Address Line | 4810 KEMP BLVD
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City | WICHITA FALLS
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State | TX
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Zip | 76308-5222
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Country | US
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Telephone | 872-231-3162
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 74008272
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City | CHICAGO
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State | IL
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Zip | 60674-8272
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Country | US
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Telephone | 702-899-0595
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Fax | 702-977-1496
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 309642
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | APRN11031715
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 4017745
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License Number State | KY
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Taxonomy #4
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | AP132721
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License Number State | TX
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