Healthcare Provider Details

I. General information

NPI: 1912837907
Provider Name (Legal Business Name): LATRECE TUCKER COLEMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 MAPLE AVE STE 305
RICHMOND VA
23226-2553
US

IV. Provider business mailing address

12250 ROWLETTS MILL CT
AMELIA COURT HOUSE VA
23002-3959
US

V. Phone/Fax

Practice location:
  • Phone: 757-271-4874
  • Fax:
Mailing address:
  • Phone: 804-586-2426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number0001275741
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: