Provider Demographics
NPI:1154953230
Name:TONEY, LATISHA L (DNP, APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:LATISHA
Middle Name:L
Last Name:TONEY
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7622 BEBE BRANCH LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-9784
Mailing Address - Country:US
Mailing Address - Phone:423-902-7399
Mailing Address - Fax:
Practice Address - Street 1:7622 BEBE BRANCH LN
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-9784
Practice Address - Country:US
Practice Address - Phone:423-902-7399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000026284363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
14613874OtherCAQH PROVIDER ID