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Edmund Emmanual Latif

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

9332 State Road 54 Ste 405, Trinity, FL 34655-1810

PECOS Enrollment

This provider is enrolled in PECOS as EDMUND LATIF.

Based on the most recent information from CMS, provider Edmund Emmanual Latif is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 9:24 AM.

Profile Details

Provider ID
1710712328
Provider Type
Individual
Full Name
Latif, Edmund Emmanual
Credential
APRN

Gender
Male
Sole Proprietor
Yes
Enumeration Date
9/4/2024
Last Updated
11/19/2024

Contact Information

Practice Location

9332 State Road 54 Ste 405, Trinity, FL 34655-1810

(727) 375-8264

Unlisted Fax

Mailing Location

2722 Heathgate Way, Land O Lakes, FL 34638-7255

(813) 847-3315

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363LF0000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License APRN11036328 Florida
Code 163WC0200X	Description Registered Nurse Nursing Service Providers	License RN9381707 Florida

Edmund Emmanual Latif

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

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Haimes, Gabriella Judith

Meier-Forbes, Betty Lou

Sawyer, Jerrica

Kassim, Lul

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Mcdermott, Heather Allison

Scudiero, Stephanie Adele