Latoria Clark-Jackson, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

PN5151340 Issued in FL

Practice address

12802 Kings Lake Dr
Gibsonton, FL 33534-3907

Phone

(813) 400-4038

NPI assigned

Jul 8, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• J 4 Dynasty, LLC

  • Licensed Practical Nurse
  • Tampa, FL
  • NPI 1760053441
  NPD Authorized official
• Latoria Jackson, LLC

  • Adult Care Home Facility
  • Gibsonton, FL
  • NPI 1518800481

  Licensed Practical Nurse

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1594166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594166400000",
    "number": "1538787353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12802 KINGS LAKE DR",
            "city": "GIBSONTON",
            "state": "FL",
            "postal_code": "335343907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12802 KINGS LAKE DR",
            "city": "GIBSONTON",
            "state": "FL",
            "postal_code": "335343907",
            "telephone_number": "813-400-4038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK-JACKSON",
        "first_name": "LATORIA",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-07-08",
        "last_updated": "2020-07-08",
        "certification_date": "2020-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "FL",
            "license": "PN5151340",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy Caroline Bell
• Melani Bello Alfonso
• Bigbend Pediatric Care, LLC
• Careone Home Health Services,LLC
• Careone Home Health Services,LLC
• Aylen Cobo Montalvan
• Luzmaria Cornelio
• Gregory James Cousin, LMT
• Hermina Cyntje
• Alexandria Shanelle Denson

• Licensed Practical Nurse in Gibsonton, FL
• Providers in Gibsonton, FL by specialty
• Licensed Practical Nurse in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.