MEDICARE: MRS. ANTONIETTE LATASHA RATLIFF

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	101YM0800X	Mental Health Counselor	IMH 14709	FL
2	164W00000X	Licensed Practical Nurse	PN 5198859	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	:	1356896088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANTONIETTE LATASHA RATLIFF

Provider Business Mailing Address
First Line	:	PO BOX 6802
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33508-6013
Country	:	US
Telephone Number	:	813-495-4276
Fax Number	:

Provider Business Practice Location Address
First Line	:	1315 E 7TH AVE
Second Line	:	SUITE 104
City	:	TAMPA
State	:	FL
Zip	:	33605-3607
Country	:	US
Telephone Number	:	813-495-4276
Fax Number	:

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

Provider Enumeration Date	:	08/23/2016
Last Update Date	:	08/23/2016

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