Provider Demographics
NPI:1407621816
Name:ELLIOTT, LATOYA NICOLE (PSYD)
Entity type:Individual
Prefix:DR
First Name:LATOYA
Middle Name:NICOLE
Last Name:ELLIOTT
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:LATOYA
Other - Middle Name:NICOLE
Other - Last Name:MOSES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5447 HOLLOW BIRCH DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32219-2783
Mailing Address - Country:US
Mailing Address - Phone:904-310-2340
Mailing Address - Fax:
Practice Address - Street 1:3020 HARTLEY RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-8231
Practice Address - Country:US
Practice Address - Phone:904-446-7104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-16
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY10814103TC0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health