1477422335 NPI number — DERRICA CURTIS LATRECE DERRICA CURTIS

Table of content: DERRICA CURTIS LATRECE DERRICA CURTIS (NPI 1477422335)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477422335 NPI number — DERRICA CURTIS LATRECE DERRICA CURTIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DERRICA CURTIS
Provider First Name:
DERRICA CURTIS
Provider Middle Name:
LATRECE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477422335
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/30/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3332 SOUTEL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32208-1349
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-465-2108
Provider Business Mailing Address Fax Number:
904-465-2108

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3332 SOUTEL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32208-1349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-465-2108
Provider Business Practice Location Address Fax Number:
904-465-2108
Provider Enumeration Date:
10/30/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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