MEDICARE: LATARCHIA S WILCOX

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	372600000X	Adult Companion	23558	FL

General Provider Information

NPI Number	:	1811553704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATARCHIA S WILCOX

Provider Business Mailing Address
First Line	:	2116 W STATE ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33606-1048
Country	:	US
Telephone Number	:	813-770-1964
Fax Number	:	813-512-8473

Provider Business Practice Location Address
First Line	:	2116 W STATE ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33606-1048
Country	:	US
Telephone Number	:	813-770-1964
Fax Number	:	813-512-8473

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2019
Last Update Date	:	05/15/2019

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Directions to “ LATARCHIA S WILCOX ” Practice Location

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