1861859183 NPI number — SKEETER THOMPSON NEMBHARD APRN

Table of content: SKEETER THOMPSON NEMBHARD APRN (NPI 1861859183)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861859183 NPI number — SKEETER THOMPSON NEMBHARD APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMPSON NEMBHARD
Provider First Name:
SKEETER
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
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:
1861859183
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
11/26/2018
NPI Reactivation Date:
12/10/2018

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1250 W STATE ROAD 434 STE 1004
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONGWOOD
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32750-4969
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-732-5753
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1250 W STATE ROAD 434 STE 1004
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONGWOOD
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32750-4969
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-732-5753
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/17/2016

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: 363LF0000X , with the licence number:  340172 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 9453519 , 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)





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