Individual
LATIFAH LATRELLE GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CMA
Contact information
Practice address
8006 JAGUAR DR, JACKSONVILLE, FL 32244-1357
(904) 930-1126
Mailing address
8006 JAGUAR DR, JACKSONVILLE, FL 32244-1357
(904) 930-1126
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
G650532875960
FL
Other
Enumeration date
04/27/2020
Last updated
05/04/2020
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