Provider Demographics
NPI:1730566043
Name:SHURINA, SUSAN
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:SHURINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8019 BAYBERRY RD
Mailing Address - Street 2:JM FAMILY COMPANY
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7411
Mailing Address - Country:US
Mailing Address - Phone:904-443-6647
Mailing Address - Fax:
Practice Address - Street 1:8019 BAYBERRY RD
Practice Address - Street 2:8019 BAYBERRY RD.
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7411
Practice Address - Country:US
Practice Address - Phone:904-443-6647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL401071164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse