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General NPI Number Information
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NPI Number | 1467250951
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Entity Type | Individual
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Provider Name | LATOYA TAMELA SHURMAN
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Gender | Female
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Dates
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Enumeration Date | 03/03/2025
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Last Update Date | 03/03/2025
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Provider Practice Location Address
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Address Line | 2235 BARRY DR S
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City | JACKSONVILLE
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State | FL
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Zip | 32208-3033
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Country | US
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Telephone | 904-475-2152
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Fax | 904-535-4501
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Provider Business Mailing Address
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Address Line | 12029 ALEXANDRA DR
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City | JACKSONVILLE
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State | FL
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Zip | 32218-8882
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Country | US
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Telephone | 904-251-9326
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number | 1712454
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License Number State | FL
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