MEDICARE: MS. LETICHI MAUDTRES TOOKES APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0808X	Psychiatric/Mental Health Registered Nurse	APRN11043821	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083117063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LETICHI MAUDTRES TOOKES APRN

Provider Business Mailing Address
First Line	:	307 STILWELL AVE
Second Line	:
City	:	PALATKA
State	:	FL
Zip	:	32177-2411
Country	:	US
Telephone Number	:	386-546-2236
Fax Number	:

Provider Business Practice Location Address
First Line	:	307 STILWELL AVE
Second Line	:
City	:	PALATKA
State	:	FL
Zip	:	32177-2411
Country	:	US
Telephone Number	:	386-546-2236
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2018
Last Update Date	:	01/15/2026

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