Provider Demographics
NPI:1023616778
Name:SINCLAIR, LATOYA TANIQUE
Entity type:Individual
Prefix:
First Name:LATOYA
Middle Name:TANIQUE
Last Name:SINCLAIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4121 E BUSCH BLVD APT 804
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-5970
Mailing Address - Country:US
Mailing Address - Phone:832-807-1319
Mailing Address - Fax:
Practice Address - Street 1:4121 E BUSCH BLVD APT 804
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-5970
Practice Address - Country:US
Practice Address - Phone:832-807-1319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11009686363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily