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Individual

LATISHA LEWIS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
8665 PAGE CT, JACKSONVILLE, FL 32220-2090
(904) 576-6625
Mailing address
8665 PAGE CT, JACKSONVILLE, FL 32220-2090
(904) 576-6625

Taxonomy

Speciality
Code
Description
License number
State
172A00000X
Driver
Primary

Other

Enumeration date
03/13/2023
Last updated
03/13/2023
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Product
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  • EDI platform