MEDICARE: LATISHA R DEAL

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	374J00000X	Doula

General Provider Information

NPI Number	:	1760326227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATISHA R DEAL

Provider Business Mailing Address
First Line	:	9973 REDFISH MARSH CIR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32219-2543
Country	:	US
Telephone Number	:	850-264-2298
Fax Number	:

Provider Business Practice Location Address
First Line	:	9973 REDFISH MARSH CIR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32219-2543
Country	:	US
Telephone Number	:	850-264-2298
Fax Number	:

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

Provider Enumeration Date	:	04/15/2026
Last Update Date	:	04/15/2026

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Directions to “ LATISHA R DEAL ” Practice Location

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