Provider Demographics
NPI:1144688375
Name:GAINES, LATRESS
Entity type:Individual
Prefix:
First Name:LATRESS
Middle Name:
Last Name:GAINES
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 1:9620 SEAVIEW DR
Mailing Address - Street 2:APT 101
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788-8020
Mailing Address - Country:US
Mailing Address - Phone:717-758-5925
Mailing Address - Fax:
Practice Address - Street 1:9620 SEAVIEW DR
Practice Address - Street 2:APT 101
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788-8020
Practice Address - Country:US
Practice Address - Phone:717-758-5925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health