MEDICARE: LATARSHA NIKON WILLIAMS

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	376J00000X	Homemaker	237632	FL
2	372600000X	Adult Companion	237632	FL

General Provider Information

NPI Number	:	1528637402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATARSHA NIKON WILLIAMS

Provider Business Mailing Address
First Line	:	5119 PORTSMOUTH AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32208-1646
Country	:	US
Telephone Number	:	904-802-8734
Fax Number	:

Provider Business Practice Location Address
First Line	:	5119 PORTSMOUTH AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32208-1646
Country	:	US
Telephone Number	:	904-802-8734
Fax Number	:

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

Provider Enumeration Date	:	06/23/2021
Last Update Date	:	06/23/2021

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Directions to “ LATARSHA NIKON WILLIAMS ” Practice Location

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