Healthcare Provider Details

I. General information

NPI: 1730566043
Provider Name (Legal Business Name): SUSAN SHURINA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2015
Last Update Date: 05/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8019 BAYBERRY RD 8019 BAYBERRY RD.
JACKSONVILLE FL
32256-7411
US

IV. Provider business mailing address

8019 BAYBERRY RD JM FAMILY COMPANY
JACKSONVILLE FL
32256-7411
US

V. Phone/Fax

Practice location:
  • Phone: 904-443-6647
  • Fax:
Mailing address:
  • Phone: 904-443-6647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number401071
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: