Provider Demographics
NPI:1447692561
Name:COOKS, LATARSHA (RN)
Entity type:Individual
Prefix:
First Name:LATARSHA
Middle Name:
Last Name:COOKS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9010 RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32208-1216
Mailing Address - Country:US
Mailing Address - Phone:904-316-0340
Mailing Address - Fax:
Practice Address - Street 1:9010 RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208-1216
Practice Address - Country:US
Practice Address - Phone:904-316-0340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-18
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9364520163W00000X, 163WP0200X, 163WW0000X, 163WX1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0000XNursing Service ProvidersRegistered NurseWound Care
No163W00000XNursing Service ProvidersRegistered Nurse
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
No163WX1500XNursing Service ProvidersRegistered NurseOstomy Care