MEDICARE: LATREACE S COLE

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	239512	FL
2	251E00000X	Home Health Agency	239512	FL
3	372600000X	Adult Companion	239512	FL
4	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1871376558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATREACE S COLE

Provider Business Mailing Address
First Line	:	8986 MERSEYSIDE AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32219-2373
Country	:	US
Telephone Number	:	904-520-3255
Fax Number	:

Provider Business Practice Location Address
First Line	:	8986 MERSEYSIDE AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32219-2373
Country	:	US
Telephone Number	:	904-520-3255
Fax Number	:

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

Provider Enumeration Date	:	08/16/2023
Last Update Date	:	04/02/2025

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Directions to “ LATREACE S COLE ” Practice Location

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