Provider Demographics
NPI:1275252280
Name:JONES, LARTRANETTE DOMINQUE
Entity Type:Individual
Prefix:
First Name:LARTRANETTE
Middle Name:DOMINQUE
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 COBALT BLUE DR APT 116
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-4376
Mailing Address - Country:US
Mailing Address - Phone:813-479-7888
Mailing Address - Fax:
Practice Address - Street 1:520 COBALT BLUE DR APT 116
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-4376
Practice Address - Country:US
Practice Address - Phone:813-479-7888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL249477376K00000X
FL236099376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's Aide