Healthcare Provider Details

I. General information

NPI: 1053596627
Provider Name (Legal Business Name): JENNIFER D THOMAS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2008
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 MOBILE INFIRMARY CIR
MOBILE AL
36607-3513
US

IV. Provider business mailing address

PO BOX 934369
ATLANTA GA
31193-4369
US

V. Phone/Fax

Practice location:
  • Phone: 251-432-4497
  • Fax: 251-432-0577
Mailing address:
  • Phone: 800-897-6169
  • Fax: 800-897-6170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11014015
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-101265
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: