Healthcare Provider Details

I. General information

NPI: 1467364943
Provider Name (Legal Business Name): LACOTTA HOSKINS-BERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15240 N 142ND AVE UNIT 1139
SURPRISE AZ
85379-8762
US

IV. Provider business mailing address

15240 N 142ND AVE UNIT 1139
SURPRISE AZ
85379-8762
US

V. Phone/Fax

Practice location:
  • Phone: 623-260-8689
  • Fax:
Mailing address:
  • Phone: 623-260-8689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: