Provider Demographics
NPI:1871376558
Name:COLE, LATREACE S
Entity type:Individual
Prefix:
First Name:LATREACE
Middle Name:S
Last Name:COLE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8986 MERSEYSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32219-2373
Mailing Address - Country:US
Mailing Address - Phone:904-520-3255
Mailing Address - Fax:
Practice Address - Street 1:8986 MERSEYSIDE AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32219-2373
Practice Address - Country:US
Practice Address - Phone:904-520-3255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-16
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL239512374U00000X, 251E00000X, 372600000X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No251E00000XAgenciesHome Health
No372600000XNursing Service Related ProvidersAdult Companion