MEDICARE: LATAERIA GIBSON

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	101Y00000X	Counselor		FL

General Provider Information

NPI Number	:	1902758956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATAERIA GIBSON

Provider Business Mailing Address
First Line	:	220 JOHN KNOX RD STE 2
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32303-6631
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 JOHN KNOX RD STE 2
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32303-6631
Country	:	US
Telephone Number	:	850-597-0370
Fax Number	:

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

Provider Enumeration Date	:	02/12/2026
Last Update Date	:	02/12/2026

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Directions to “ LATAERIA GIBSON ” Practice Location

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