Provider Demographics
NPI:1346814183
Name:PLATTS, LASEANE JAMELLE
Entity type:Individual
Prefix:
First Name:LASEANE
Middle Name:JAMELLE
Last Name:PLATTS
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 1:6028 CHESTER AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-2285
Mailing Address - Country:US
Mailing Address - Phone:904-616-8313
Mailing Address - Fax:
Practice Address - Street 1:6028 CHESTER AVE STE 200
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2285
Practice Address - Country:US
Practice Address - Phone:904-274-2863
Practice Address - Fax:904-467-3137
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-17
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2152461376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL120463600Medicaid