Individual
STACY LATACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
301 FISHER ST, BILOXI, MS 39534-2508
(228) 376-4932
Mailing address
10253 LAKE FOREST DR, OCEAN SPRINGS, MS 39565-2014
Taxonomy
Speciality
Code
Description
License number
State
163WD0400X
Diabetes Educator Registered Nurse
Primary
878067
MS
Other
Enumeration date
02/11/2025
Last updated
02/11/2025
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