Individual
LATRENA M THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
14091 SUMMER BREEZE DR E, JACKSONVILLE, FL 32218-8913
(804) 502-5840
(904) 485-8541
Mailing address
PO BOX 77581, JACKSONVILLE, FL 32226-7581
(804) 502-5840
(904) 485-8541
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
15IV043
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019341700
—
FL
Enumeration date
05/03/2018
Last updated
05/03/2018
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