# LATORIA JACKSON, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518800481
- **Authorized official:** LATORIA JACKSON (OWNER/ADMINSTRATOR)
- **Authorized official phone:** (866) 274-4600

## Contact information

- **Practice address:** 12802 KINGS LAKE DR, GIBSONTON, FL 33534-3907
- **Practice address phone:** (866) 274-4600
- **Mailing address:** 12802 KINGS LAKE DR, GIBSONTON, FL 33534-3907
- **Mailing address phone:** (866) 274-4600

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 164W00000X | Licensed Practical Nurse | — | NULL | — |
| 164W00000X | Licensed Practical Nurse | — | — | — |
| 311ZA0620X | Adult Care Home Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 04/14/2026
- **Last updated:** 04/14/2026