Provider Demographics
NPI:1467250951
Name:SHURMAN, LATOYA TAMELA
Entity type:Individual
Prefix:
First Name:LATOYA
Middle Name:TAMELA
Last Name:SHURMAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12029 ALEXANDRA DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-8882
Mailing Address - Country:US
Mailing Address - Phone:904-251-9326
Mailing Address - Fax:
Practice Address - Street 1:2235 BARRY DR S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208-3033
Practice Address - Country:US
Practice Address - Phone:904-475-2152
Practice Address - Fax:904-535-4501
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17124543104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness