Provider Demographics
NPI:1174416127
Name:CALLAWAY, LATOSHA Y
Entity type:Individual
Prefix:
First Name:LATOSHA
Middle Name:Y
Last Name:CALLAWAY
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 1:939 E PARKER ST
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-1992
Mailing Address - Country:US
Mailing Address - Phone:863-223-9655
Mailing Address - Fax:
Practice Address - Street 1:939 E PARKER ST
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-1992
Practice Address - Country:US
Practice Address - Phone:863-223-9655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide