Provider Demographics
NPI:1932662467
Name:GASKINS, LATESHA VONTRICE
Entity Type:Individual
Prefix:
First Name:LATESHA
Middle Name:VONTRICE
Last Name:GASKINS
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 1:6763 KRENSON OAKS CIR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-2157
Mailing Address - Country:US
Mailing Address - Phone:813-468-5303
Mailing Address - Fax:
Practice Address - Street 1:6763 KRENSON OAKS CIR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33810-2157
Practice Address - Country:US
Practice Address - Phone:813-468-5303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-11
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL17000056650251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services