Provider Demographics
NPI:1699931857
Name:SEAL, LATASHA M (NP)
Entity type:Individual
Prefix:
First Name:LATASHA
Middle Name:M
Last Name:SEAL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LATASHA
Other - Middle Name:
Other - Last Name:JARNAGIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1179 HIGHWAY 11W
Mailing Address - Street 2:
Mailing Address - City:BEAN STATION
Mailing Address - State:TN
Mailing Address - Zip Code:37708-5809
Mailing Address - Country:US
Mailing Address - Phone:865-993-1070
Mailing Address - Fax:865-993-1075
Practice Address - Street 1:1179 HIGHWAY 11W
Practice Address - Street 2:
Practice Address - City:BEAN STATION
Practice Address - State:TN
Practice Address - Zip Code:37708-5809
Practice Address - Country:US
Practice Address - Phone:865-993-1070
Practice Address - Fax:865-993-1075
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13557363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily