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General NPI Number Information
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NPI Number | 1790401602
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Entity Type | Individual
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Provider Name | LATASHA NYE BROCKINGTON
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Gender | Female
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Dates
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Enumeration Date | 10/13/2022
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Last Update Date | 05/28/2025
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Provider Practice Location Address
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Address Line | 6312 SEVEN CORNERS CTR # 386
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City | FALLS CHURCH
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State | VA
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Zip | 22044-2409
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Country | US
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Telephone | 202-643-5571
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Fax |
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Provider Business Mailing Address
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Address Line | 7000 S KENFIG DR
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City | FALLS CHURCH
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State | VA
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Zip | 22042-3866
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Country | US
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Telephone | 843-834-4225
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number |
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 374J00000X
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Taxonomy Name | Doula
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License Number |
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | 0129000222
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License Number State | VA
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