Provider Demographics
NPI:1144911561
Name:DEVANE, LATOYA
Entity type:Individual
Prefix:
First Name:LATOYA
Middle Name:
Last Name:DEVANE
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 1:1831 DORIC DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-3536
Mailing Address - Country:US
Mailing Address - Phone:954-393-9942
Mailing Address - Fax:
Practice Address - Street 1:221 W PARK AVE # 11082
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-7715
Practice Address - Country:US
Practice Address - Phone:954-393-9942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-17
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL23000228407343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)