1053596627 NPI number — JENNIFER D THOMAS CRNA

Table of content: JENNIFER D THOMAS CRNA (NPI 1053596627)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053596627 NPI number — JENNIFER D THOMAS CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMAS
Provider First Name:
JENNIFER
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053596627
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/12/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 934369
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31193-4369
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-897-6169
Provider Business Mailing Address Fax Number:
800-897-6170

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 MOBILE INFIRMARY CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36607-3513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-432-4497
Provider Business Practice Location Address Fax Number:
251-432-0577
Provider Enumeration Date:
01/02/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  APRN11014015 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 1-101265 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 051546112 . This is a "BC OF AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051546115 . This is a "BC OF AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009913619 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051546114 . This is a "BC OF AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009913617 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009913616 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009913618 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 113797500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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