Provider Demographics
NPI:1679530166
Name:ROTHMAN, J LATAYNE (FNP)
Entity type:Individual
Prefix:MRS
First Name:J
Middle Name:LATAYNE
Last Name:ROTHMAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5116 HARVARD ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-5806
Mailing Address - Country:US
Mailing Address - Phone:806-355-9702
Mailing Address - Fax:806-468-1807
Practice Address - Street 1:6010 W AMARILLO BLVD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1990
Practice Address - Country:US
Practice Address - Phone:806-355-9702
Practice Address - Fax:806-468-1807
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX438983163WP2201X
TX363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily