Healthcare Provider Details

I. General information

NPI: 1386313419
Provider Name (Legal Business Name): LATRELL D GASKIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2021
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3664 BRENTWOOD BLVD
JACKSONVILLE FL
32206-1869
US

IV. Provider business mailing address

3664 BRENTWOOD BLVD
JACKSONVILLE FL
32206-1869
US

V. Phone/Fax

Practice location:
  • Phone: 904-731-6109
  • Fax: 904-250-5902
Mailing address:
  • Phone: 904-731-6109
  • Fax: 904-250-5902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: LATRELL DELORES GASKIN
Title or Position: OWNER
Credential:
Phone: 904-731-6109