Healthcare Provider Details

I. General information

NPI: 1912583220
Provider Name (Legal Business Name): LATRESSIA MAXWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2021
Last Update Date: 03/18/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4311 CAMERON PRESERVE CIR APT 202
KISSIMMEE FL
34746-6319
US

IV. Provider business mailing address

4311 CAMERON PRESERVE CIR APT 202
KISSIMMEE FL
34746-6319
US

V. Phone/Fax

Practice location:
  • Phone: 407-715-7040
  • Fax:
Mailing address:
  • Phone: 407-715-7040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: