Provider Demographics
NPI:1740824481
Name:JONES, LATASHA IRENE
Entity type:Individual
Prefix:MISS
First Name:LATASHA
Middle Name:IRENE
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:LATASHA
Other - Middle Name:IRENE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1180 5TH AVE N EXT
Mailing Address - Street 2:UNIT I
Mailing Address - City:SURFSIDE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29575
Mailing Address - Country:US
Mailing Address - Phone:843-957-8278
Mailing Address - Fax:
Practice Address - Street 1:1180 5TH AVE N EXT
Practice Address - Street 2:UNIT I
Practice Address - City:SURFSIDE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29575
Practice Address - Country:US
Practice Address - Phone:843-957-8278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-06
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36536251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health