Provider Demographics
NPI:1922696343
Name:AYRA, THALIA T (APRN)
Entity Type:Individual
Prefix:MISS
First Name:THALIA
Middle Name:T
Last Name:AYRA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16630 SW 141ST CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-2084
Mailing Address - Country:US
Mailing Address - Phone:786-515-8579
Mailing Address - Fax:
Practice Address - Street 1:16630 SW 141ST CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-2084
Practice Address - Country:US
Practice Address - Phone:786-515-8579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-03
Last Update Date:2021-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11010261208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice