Provider Demographics
NPI:1144454992
Name:MARTIN, LATONAH RANEE
Entity type:Individual
Prefix:MRS
First Name:LATONAH
Middle Name:RANEE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 E MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:FL
Mailing Address - Zip Code:32344-5099
Mailing Address - Country:US
Mailing Address - Phone:850-445-5094
Mailing Address - Fax:
Practice Address - Street 1:67 E MEADOW RD
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:FL
Practice Address - Zip Code:32344-5099
Practice Address - Country:US
Practice Address - Phone:850-445-5094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-07
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL693584296171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor