Individual
LATOYA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
707 W 113TH AVE, TAMPA, FL 33612-5617
(813) 638-2686
Mailing address
707 W 113TH AVE, TAMPA, FL 33612-5617
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN5214640
FL
Other
Enumeration date
07/31/2026
Last updated
07/31/2026
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