Healthcare Provider Details

I. General information

NPI: 1134614977
Provider Name (Legal Business Name): THALIA CHRISTINA FORD ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

668 MAITLAND AVE
ALTAMONTE SPRINGS FL
32701-6862
US

IV. Provider business mailing address

668 MAITLAND AVE
ALTAMONTE SPRINGS FL
32701-6862
US

V. Phone/Fax

Practice location:
  • Phone: 407-675-3220
  • Fax: 407-675-3216
Mailing address:
  • Phone: 407-675-3220
  • Fax: 407-675-3216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9306565
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number9306565
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: