1073519245 NPI number — MRS. CAROL S. THOMPSON CNM

Table of content: MRS. CAROL S. THOMPSON CNM (NPI 1073519245)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073519245 NPI number — MRS. CAROL S. THOMPSON CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMPSON
Provider First Name:
CAROL
Provider Middle Name:
S.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CNM
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:
1073519245
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/11/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13110 ELK MOUNTAIN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIVERVIEW
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33579-7182
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-349-7569
Provider Business Mailing Address Fax Number:
813-349-7569

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
508 N MARYLAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLANT CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33563-3820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-349-7600
Provider Business Practice Location Address Fax Number:
813-938-6423
Provider Enumeration Date:
06/22/2005

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: 367A00000X , with the licence number:  ARNP1957232 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 033792700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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