Provider Demographics
NPI:1053711085
Name:HARVILLE, LATRICE (LPN)
Entity type:Individual
Prefix:
First Name:LATRICE
Middle Name:
Last Name:HARVILLE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2719 W THARPE ST APT 38
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-8659
Mailing Address - Country:US
Mailing Address - Phone:850-322-4569
Mailing Address - Fax:850-681-6003
Practice Address - Street 1:2719 W THARPE ST APT 38
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-8659
Practice Address - Country:US
Practice Address - Phone:850-322-4569
Practice Address - Fax:850-681-6003
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5212191164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse