MEDICARE: LATESIA LATONYA MILES RN

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	163W00000X	Registered Nurse	9522588	FL
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN11040477	FL
3	164W00000X	Licensed Practical Nurse	PN 5157469	FL

General Provider Information

NPI Number	:	1902204217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATESIA LATONYA MILES RN

Provider Business Mailing Address
First Line	:	3523 NW 14TH CT
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33311-8489
Country	:	US
Telephone Number	:	954-560-6499
Fax Number	:

Provider Business Practice Location Address
First Line	:	3523 NW 14TH CT
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33311-8489
Country	:	US
Telephone Number	:	954-560-6499
Fax Number	:

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

Provider Enumeration Date	:	12/18/2014
Last Update Date	:	09/29/2025

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