Individual
NICOLE LATGIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5121 S COTTONWOOD ST, MURRAY, UT 84107-5701
(801) 507-3462
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
13698599-1206
UT
363A00000X
Physician Assistant
25MP00641600
NJ
363AS0400X
Surgical Physician Assistant
Primary
25MP00641600
NJ
363AS0400X
Surgical Physician Assistant
—
—
Other
Enumeration date
07/20/2021
Last updated
03/27/2026
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