Provider Demographics
NPI:1467336008
Name:LATIMORE, YAZMINE CORINNE
Entity type:Individual
Prefix:
First Name:YAZMINE
Middle Name:CORINNE
Last Name:LATIMORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 ACACIA LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-7063
Mailing Address - Country:US
Mailing Address - Phone:803-741-4998
Mailing Address - Fax:
Practice Address - Street 1:1070 ACACIA LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-7063
Practice Address - Country:US
Practice Address - Phone:803-741-4998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant