MEDICARE: LATOYA TAMELA SHURMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3104A0625X	Assisted Living Facility (Mental Illness)	1712454	FL

General Provider Information

NPI Number	:	1467250951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATOYA TAMELA SHURMAN

Provider Business Mailing Address
First Line	:	12029 ALEXANDRA DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-8882
Country	:	US
Telephone Number	:	904-251-9326
Fax Number	:

Provider Business Practice Location Address
First Line	:	2235 BARRY DR S
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32208-3033
Country	:	US
Telephone Number	:	904-475-2152
Fax Number	:	904-535-4501

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2025
Last Update Date	:	03/03/2025

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