Individual
LATAVIA MARIE WELLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
3191 HARBOR BLVD STE A, PORT CHARLOTTE, FL 33952-6755
(941) 883-4518
Mailing address
4310 METRO PKWY STE 205, FORT MYERS, FL 33916-9416
(239) 223-2751
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
RN9542926
FL
Other
Enumeration date
12/09/2020
Last updated
12/09/2020
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