Organization
CAMPBELL'S MULTI SERVICE OUTREACH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LATANGRA MCINTOSH MCINTOSH PMHNP (OWNER)
(863) 860-4516
Entity
Organization
Contact information
Practice address
211 DORIS DR, LAKELAND, FL 33813-1006
(863) 860-4516
(863) 837-4413
Mailing address
715 HEMENWAY DR NE, WINTER HAVEN, FL 33881-2700
(863) 860-4516
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
05/23/2022
Last updated
05/23/2022
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