MEDICARE: MISS SHIRLEY THELEAU FNP-BC

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	363LF0000X	Family Nurse Practitioner	APRN11042997	FL

General Provider Information

NPI Number	:	1477429215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS SHIRLEY THELEAU FNP-BC

Provider Business Mailing Address
First Line	:	1990 NE 159TH ST
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-5750
Country	:	US
Telephone Number	:	786-366-1362
Fax Number	:

Provider Business Practice Location Address
First Line	:	1990 NE 159TH ST
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-5750
Country	:	US
Telephone Number	:	786-366-1362
Fax Number	:

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

Provider Enumeration Date	:	10/16/2025
Last Update Date	:	12/17/2025

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