Provider Demographics
NPI:1730983974
Name:AVERY, LATOYA S
Entity type:Individual
Prefix:
First Name:LATOYA
Middle Name:S
Last Name:AVERY
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 1:4747 N PINE HILLS RD APT 2024747N
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-1983
Mailing Address - Country:US
Mailing Address - Phone:689-867-6356
Mailing Address - Fax:
Practice Address - Street 1:4747 N PINE HILLS RD APT 202
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-1970
Practice Address - Country:US
Practice Address - Phone:689-867-6356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-04
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL07489084Z372600000X
FL372600000X
FL07484330Z372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion