Provider Demographics
NPI:1689660425
Name:LATTA, TINA M (DNS, FNP-C MSN, ,)
Entity type:Individual
Prefix:MS
First Name:TINA
Middle Name:M
Last Name:LATTA
Suffix:
Gender:F
Credentials:DNS, FNP-C MSN, ,
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:M
Other - Last Name:LATTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:260 FREMONT ST STE B
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49017
Mailing Address - Country:US
Mailing Address - Phone:269-245-8166
Mailing Address - Fax:
Practice Address - Street 1:260 FREMONT ST
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017
Practice Address - Country:US
Practice Address - Phone:269-245-8166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704205664363LF0000X
IN71003623A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201027540Medicaid
IN000000725157OtherANTHEM
IN127356OtherSIHO
INM400048619Medicare PIN