MEDICARE: TEAJUANI LATASHA MIMS

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	374U00000X	Home Health Aide	IHCP2331	SC

General Provider Information

NPI Number	:	1033046768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TEAJUANI LATASHA MIMS

Provider Business Mailing Address
First Line	:	2 CORPUS CHRISTIE PL STE 200
Second Line	:
City	:	HILTON HEAD
State	:	SC
Zip	:	29928-1712
Country	:	US
Telephone Number	:	912-275-3493
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 CORPUS CHRISTIE PL STE 200
Second Line	:
City	:	HILTON HEAD
State	:	SC
Zip	:	29928-1712
Country	:	US
Telephone Number	:	912-275-3493
Fax Number	:

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

Provider Enumeration Date	:	05/06/2026
Last Update Date	:	05/06/2026

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Directions to “ TEAJUANI LATASHA MIMS ” Practice Location

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