Provider Demographics
NPI:1811553704
Name:WILCOX, LATARCHIA S
Entity Type:Individual
Prefix:
First Name:LATARCHIA
Middle Name:S
Last Name:WILCOX
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 1:2116 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-1048
Mailing Address - Country:US
Mailing Address - Phone:813-770-1964
Mailing Address - Fax:813-512-8473
Practice Address - Street 1:2116 W STATE ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-1048
Practice Address - Country:US
Practice Address - Phone:813-770-1964
Practice Address - Fax:813-512-8473
Is Sole Proprietor?:No
Enumeration Date:2019-05-15
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23558372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion