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Organization
CAMPBELL'S MULTI SERVICE OUTREACH CENTER
Active
Organization
CAMPBELL'S MULTI SERVICE OUTREACH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LATANGRA MCINTOSH MCINTOSH PMHNP (OWNER)
(863) 860-4516
Entity
Organization
Contact information
Practice address
211 DORIS DR, LAKELAND, FL 33813-1006
(863) 860-4516
(863) 837-4413
Mailing address
715 HEMENWAY DR NE, WINTER HAVEN, FL 33881-2700
(863) 860-4516
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
05/23/2022
Last updated
05/23/2022
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