MEDICARE: MRS. SARA NICOLE THOMPSON PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA9108278	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	MEDICARE	OTHER	FL	MEDICARE
4	KQ667	OTHER	FL	FL MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	PA9108278	OTHER	FL	LICENSE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508162645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARA NICOLE THOMPSON PA-C

Provider Business Mailing Address
First Line	:	3300 S FISKE BLVD
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-4306
Country	:	US
Telephone Number	:	321-308-2660
Fax Number	:

Provider Business Practice Location Address
First Line	:	1421 MALABAR RD NE STE 200
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32907-2559
Country	:	US
Telephone Number	:	321-308-2660
Fax Number	:	321-984-9303

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2011
Last Update Date	:	07/20/2022

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Directions to “ MRS. SARA NICOLE THOMPSON PA-C” Practice Location

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