Provider Demographics
NPI:1871101691
Name:MCCLELLAN, LATASHA YVETTE (RN, APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:LATASHA
Middle Name:YVETTE
Last Name:MCCLELLAN
Suffix:
Gender:F
Credentials:RN, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5776 SAINT AUGUSTINE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-8046
Mailing Address - Country:US
Mailing Address - Phone:904-448-4700
Mailing Address - Fax:
Practice Address - Street 1:5776 SAINT AUGUSTINE RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8046
Practice Address - Country:US
Practice Address - Phone:386-487-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-17
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9452093163W00000X
FLAPRN11019091363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse