Provider Demographics
NPI:1518591239
Name:TRAYLOR, LATASHA RENEE' (LVN)
Entity type:Individual
Prefix:MRS
First Name:LATASHA
Middle Name:RENEE'
Last Name:TRAYLOR
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8750 FOX MEADOW WAY
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76123-2507
Mailing Address - Country:US
Mailing Address - Phone:817-715-8208
Mailing Address - Fax:
Practice Address - Street 1:8750 FOX MEADOW WAY
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76123-2507
Practice Address - Country:US
Practice Address - Phone:817-715-8208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX231797164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse