Provider Demographics
NPI:1144875873
Name:FLEETWOOD, LATOYA FEMALE
Entity type:Individual
Prefix:
First Name:LATOYA
Middle Name:FEMALE
Last Name:FLEETWOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LATOYA
Other - Middle Name:LYNNELL
Other - Last Name:FLEETWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2307 NORCOVA AVE APT G201
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23513-2784
Mailing Address - Country:US
Mailing Address - Phone:904-624-2265
Mailing Address - Fax:
Practice Address - Street 1:2307 NORCOVA AVE APT G201
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23513-2784
Practice Address - Country:US
Practice Address - Phone:904-624-2265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1401176445163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health