Provider Demographics
NPI:1538559778
Name:VICTOR, LATOYA (FNP, PMHNP)
Entity type:Individual
Prefix:
First Name:LATOYA
Middle Name:
Last Name:VICTOR
Suffix:
Gender:F
Credentials:FNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8630 FENTON ST STE 1204
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3808
Mailing Address - Country:US
Mailing Address - Phone:301-340-7525
Mailing Address - Fax:301-495-0318
Practice Address - Street 1:8630 FENTON ST STE 1200
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3808
Practice Address - Country:US
Practice Address - Phone:301-585-1250
Practice Address - Fax:301-585-6289
Is Sole Proprietor?:No
Enumeration Date:2015-01-26
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR185965363LP2300X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care