Individual
LATRALL SIMON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12458 CONDOR DR, JACKSONVILLE, FL 32223-3711
(904) 508-2687
(904) 379-5457
Mailing address
12458 CONDOR DR, JACKSONVILLE, FL 32223-3711
(904) 508-2687
(904) 379-5457
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001477397
—
FL
Enumeration date
12/16/2016
Last updated
10/03/2017
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