Provider Demographics
NPI:1982493409
Name:HARRISON, LATASHA DENISE
Entity type:Individual
Prefix:
First Name:LATASHA
Middle Name:DENISE
Last Name:HARRISON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4215 BRUNSWICK DR
Mailing Address - Street 2:
Mailing Address - City:EIGHT MILE
Mailing Address - State:AL
Mailing Address - Zip Code:36613-3349
Mailing Address - Country:US
Mailing Address - Phone:251-654-7261
Mailing Address - Fax:
Practice Address - Street 1:4215 BRUNSWICK DR
Practice Address - Street 2:
Practice Address - City:EIGHT MILE
Practice Address - State:AL
Practice Address - Zip Code:36613-3349
Practice Address - Country:US
Practice Address - Phone:251-654-7261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No172A00000XOther Service ProvidersDriver
No372600000XNursing Service Related ProvidersAdult Companion