Individual
LATIFA BOUKARROU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1651 SE TIFFANY AVE, SUITE 101, PORT SAINT LUCIE, FL 34952-7564
(772) 419-3810
(772) 419-3811
Mailing address
PO BOX 417, STUART, FL 34995-0417
(772) 223-2832
(772) 223-5646
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
84996
WI
2084N0400X
Neurology Physician
Primary
A156992
CA
2084N0400X
Neurology Physician
MD449015
PA
2084N0400X
Neurology Physician
MD61603092
WA
2084N0400X
Neurology Physician
ME129352
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
TP618
FLORIDA BLUE
FL
Enumeration date
04/30/2010
Last updated
05/14/2025
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