Provider Demographics
NPI:1336013531
Name:MCDANIEL, LATIA (NURSE)
Entity type:Individual
Prefix:MS
First Name:LATIA
Middle Name:
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 BLANDING BLVD STE 13
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-5813
Mailing Address - Country:US
Mailing Address - Phone:808-482-4111
Mailing Address - Fax:
Practice Address - Street 1:700 BLANDING BLVD STE 13
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-5813
Practice Address - Country:US
Practice Address - Phone:808-482-4111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-01
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5234886164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty