Individual
LATREVET THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
119 SPRINGHALL DR, GOOSE CREEK, SC 29445-5368
(843) 266-2520
Mailing address
PO BOX 530062, ATLANTA, GA 30353-0062
(800) 491-0909
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
30643
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NN1718
—
SC
Enumeration date
07/18/2025
Last updated
04/15/2026
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