Organization
J 4 DYNASTY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LATORIA CLARK-JACKSON LPN (OWNER/MGR)
(813) 606-5010
Entity
Organization
Contact information
Practice address
10150 HIGHLAND MANOR DR STE 200-106, TAMPA, FL 33610-9713
(813) 606-5010
(877) 228-8577
Mailing address
10150 HIGHLAND MANOR DR STE 200-106, TAMPA, FL 33610-9713
(813) 606-5010
(877) 228-8577
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
—
—
253Z00000X
In Home Supportive Care Agency
—
—
372500000X
Chore Provider
—
—
372600000X
Adult Companion
—
—
374U00000X
Home Health Aide
—
—
376J00000X
Homemaker
—
—
Other
Enumeration date
07/05/2021
Last updated
07/05/2021
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