1720216799 NPI number — MS. LATOYA DANIELLE HOWARD BA

Table of content: MS. LATOYA DANIELLE HOWARD BA (NPI 1720216799)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720216799 NPI number — MS. LATOYA DANIELLE HOWARD BA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOWARD
Provider First Name:
LATOYA
Provider Middle Name:
DANIELLE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
BA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720216799
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/29/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8050 103RD ST
Provider Second Line Business Mailing Address:
APT C11
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32210-6646
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-463-3523
Provider Business Mailing Address Fax Number:
904-677-8019

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4570 SAINT JOHNS AVE
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32210-1848
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-887-3624
Provider Business Practice Location Address Fax Number:
904-677-8019
Provider Enumeration Date:
06/29/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 360358001 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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