Healthcare Provider Details

I. General information

NPI: 1073967220
Provider Name (Legal Business Name): LATASHA R HAYES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2016
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4266 SUNBEAM RD
JACKSONVILLE FL
32257-2425
US

IV. Provider business mailing address

4266 SUNBEAM RD
JACKSONVILLE FL
32257-2425
US

V. Phone/Fax

Practice location:
  • Phone: 904-268-5200
  • Fax:
Mailing address:
  • Phone: 904-268-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01082959A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberME159040
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME159040
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: