=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255894085
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THURLOW & ASSOCIATES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2019
-----------------------------------------------------
Last Update Date | 04/09/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13336 92ND AVE
-----------------------------------------------------
City | SEMINOLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33776-2426
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-565-3990
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13336 92ND AVE
-----------------------------------------------------
City | SEMINOLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33776-2426
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-565-3990
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. ALBERT H THURLOW III
-----------------------------------------------------
Credential | ARNP
-----------------------------------------------------
Telephone | 727-565-3990
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------