Provider Demographics
NPI:1053745216
Name:TATE, LATOYA (RN)
Entity type:Individual
Prefix:
First Name:LATOYA
Middle Name:
Last Name:TATE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 BRAEBURN BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHLANDS
Mailing Address - State:NC
Mailing Address - Zip Code:28574-8463
Mailing Address - Country:US
Mailing Address - Phone:252-241-5678
Mailing Address - Fax:
Practice Address - Street 1:128 BRAEBURN BLVD
Practice Address - Street 2:
Practice Address - City:RICHLANDS
Practice Address - State:NC
Practice Address - Zip Code:28574-8463
Practice Address - Country:US
Practice Address - Phone:252-241-5678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-23
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA781522163W00000X
NC203583163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse