Individual
LATOVA NICHELLE QUATTLEBAUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1228 HARDEN ST STE B, COLUMBIA, SC 29204-1800
(803) 733-5969
(803) 753-5591
Mailing address
PO BOX 3788, COLUMBIA, SC 29230-3788
(803) 733-5969
(803) 753-5591
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
21979
SC
363LF0000X
Family Nurse Practitioner
21979
SC
Other
Enumeration date
09/10/2018
Last updated
12/13/2021
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