Thomas, Latrena M

Thomas, Latrena M is an sole proprietor health care provider with primary practice located at 14091 Summer Breeze Dr E , Jacksonville FL 32218-8913. She recently has only one registered license in Residential Treatment Facilities / Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities, which is considered as her primary health care specialty. Thomas, Latrena M can be contacted via phone (804) 502-5840.

Contact Information

Primary practice address
14091 Summer Breeze Dr E Jacksonville FL 32218-8913
Phone: (804) 502-5840
Fax: (904) 485-8541
Website:
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Health care specialties

SpecialtyCodeLicense #State
Residential Treatment Facilities / Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities 320600000X 15IV043 Florida

Profile Details

NPI number 1760971923
LBN Legal business name Thomas, Latrena M
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date May 3rd, 2018
Last updated May 3rd, 2018 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1760971923 NPPES
Florida MEDICAID 019341700

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