Organization
LATORIA JACKSON, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LATORIA JACKSON (OWNER/ADMINSTRATOR)
(866) 274-4600
Entity
Organization
Contact information
Practice address
12802 KINGS LAKE DR, GIBSONTON, FL 33534-3907
(866) 274-4600
Mailing address
12802 KINGS LAKE DR, GIBSONTON, FL 33534-3907
(866) 274-4600
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
—
—
311ZA0620X
Adult Care Home Facility
Primary
—
—
Other
Enumeration date
04/14/2026
Last updated
04/14/2026
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