Active NPI
Tracey Judith Latia Senior, STNA
- Nurse's Aide
- Canton, OH
National Provider Identifier
1619708260
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse's Aide
- License
- 602837170524
- Practice address
- 4104 Orchard Dale Dr NW Apt N
Canton, OH 44709-2095 - Phone
- (716) 510-4216
- NPI assigned
- Aug 13, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse's Aide | 376K00000X | 602837170524 | OH | Primary |
Addresses
Primary practice location
4104 Orchard Dale Dr NW Apt N
Canton, OH 44709-2095
Mailing address
4104 Orchard Dale Dr NW Apt N
Canton, OH 44709-2095
Phone (716) 510-4216
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 602837170524 | OH | MD | Nurse's Aide |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1723507200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1723507200000",
"number": "1619708260",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4104 ORCHARD DALE DR NW APT N",
"city": "CANTON",
"state": "OH",
"postal_code": "447092095",
"telephone_number": "716-510-4216"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4104 ORCHARD DALE DR NW APT N",
"city": "CANTON",
"state": "OH",
"postal_code": "447092095",
"telephone_number": "716-510-4216"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SENIOR",
"first_name": "TRACEY",
"middle_name": "JUDITH LATIA",
"credential": "STNA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-08-13",
"last_updated": "2024-08-13",
"certification_date": "2024-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "376K00000X",
"taxonomy_group": "",
"desc": "Nurse's Aide",
"state": "OH",
"license": "602837170524",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Canton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.