Provider Demographics
NPI:1093453482
Name:ARCHANGEL, LATAYSHA D (ADMINISTRATION)
Entity type:Individual
Prefix:MRS
First Name:LATAYSHA
Middle Name:D
Last Name:ARCHANGEL
Suffix:
Gender:F
Credentials:ADMINISTRATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7207 BUCANERO
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054-5534
Mailing Address - Country:US
Mailing Address - Phone:469-515-2227
Mailing Address - Fax:689-222-7273
Practice Address - Street 1:7207 BUCANERO
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75054-5534
Practice Address - Country:US
Practice Address - Phone:469-515-2227
Practice Address - Fax:689-222-7273
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXA9635307Medicaid