Provider Demographics
NPI:1679277206
Name:SHURNS, THALIA (NP)
Entity type:Individual
Prefix:
First Name:THALIA
Middle Name:
Last Name:SHURNS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 S PEBBLE BEACH BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:SUN CITY CENTER
Mailing Address - State:FL
Mailing Address - Zip Code:33573-5708
Mailing Address - Country:US
Mailing Address - Phone:772-538-5008
Mailing Address - Fax:
Practice Address - Street 1:137 S PEBBLE BEACH BLVD STE 101
Practice Address - Street 2:
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-5708
Practice Address - Country:US
Practice Address - Phone:772-538-5008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9446625163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty