MEDICARE: MS. LATISHA M HILL MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	ISW9406	FL

General Provider Information

NPI Number	:	1003207150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LATISHA M HILL MSW

Provider Business Mailing Address
First Line	:	3694 HARTSFIELD FOREST CIR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32277-3851
Country	:	US
Telephone Number	:	757-560-1444
Fax Number	:

Provider Business Practice Location Address
First Line	:	4720 SALISBURY RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-6101
Country	:	US
Telephone Number	:	904-493-6190
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/11/2015
Last Update Date	:	02/11/2015

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