Provider Demographics
NPI:1467802843
Name:JUAREZ, THANIA (NP-C)
Entity Type:Individual
Prefix:
First Name:THANIA
Middle Name:
Last Name:JUAREZ
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:336-474-3433
Mailing Address - Fax:336-474-8165
Practice Address - Street 1:1122 RANDOLPH ST STE 110
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-5730
Practice Address - Country:US
Practice Address - Phone:336-474-3433
Practice Address - Fax:336-474-8165
Is Sole Proprietor?:No
Enumeration Date:2016-06-16
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC284266363LF0000X
NC5008634363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily