Provider Demographics
NPI:1942030416
Name:COLEMAN, LATONIA D (RN)
Entity type:Individual
Prefix:
First Name:LATONIA
Middle Name:D
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5130 SABLE CHIME DR
Mailing Address - Street 2:
Mailing Address - City:WIMAUMA
Mailing Address - State:FL
Mailing Address - Zip Code:33598-4170
Mailing Address - Country:US
Mailing Address - Phone:813-394-0902
Mailing Address - Fax:
Practice Address - Street 1:5130 SABLE CHIME DR
Practice Address - Street 2:
Practice Address - City:WIMAUMA
Practice Address - State:FL
Practice Address - Zip Code:33598-4170
Practice Address - Country:US
Practice Address - Phone:813-394-0902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-07
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9419620163W00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No163W00000XNursing Service ProvidersRegistered Nurse