Healthcare Provider Details

I. General information

NPI: 1750054177
Provider Name (Legal Business Name): THAYSA COSTA DUARTE FNP, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2021
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 E 15TH AVE
GULF SHORES AL
36542-3516
US

IV. Provider business mailing address

156 E 15TH AVE
GULF SHORES AL
36542-3516
US

V. Phone/Fax

Practice location:
  • Phone: 251-948-4290
  • Fax:
Mailing address:
  • Phone: 251-948-4290
  • Fax: 251-948-7682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-137309
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: