Provider Demographics
NPI:1487232799
Name:CHANCE, LATRICA M (CNA MED TECH CARGIV)
Entity Type:Individual
Prefix:MRS
First Name:LATRICA
Middle Name:M
Last Name:CHANCE
Suffix:
Gender:F
Credentials:CNA MED TECH CARGIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 NE 6TH ST UNIT 2324
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33061-2614
Mailing Address - Country:US
Mailing Address - Phone:954-951-7899
Mailing Address - Fax:
Practice Address - Street 1:3350 E ATLANTIC BLVD STE 209
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-5743
Practice Address - Country:US
Practice Address - Phone:954-258-3714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-30
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL409579163WH0200X
FL406578314000000X, 376K00000X
372600000X, 376J00000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No372600000XNursing Service Related ProvidersAdult Companion
No376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110775100Medicaid