Individual
LATASHA YVETTE MCCLELLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, APRN, PMHNP-BC
Contact information
Practice address
5776 SAINT AUGUSTINE RD, JACKSONVILLE, FL 32207-8046
(386) 487-0800
Mailing address
5776 SAINT AUGUSTINE RD, JACKSONVILLE, FL 32207-8046
(904) 448-4700
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN9452093
FL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
APRN11019091
FL
Other
Enumeration date
07/17/2020
Last updated
12/02/2024
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