Healthcare Provider Details

I. General information

NPI: 1821374950
Provider Name (Legal Business Name): DANELLE LEE THOMPSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2011
Last Update Date: 10/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 N ROBERTS AVE
ARCADIA FL
34266-9580
US

IV. Provider business mailing address

PO BOX 2177
ARCADIA FL
34265-2177
US

V. Phone/Fax

Practice location:
  • Phone: 863-494-8401
  • Fax:
Mailing address:
  • Phone: 863-494-3535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9258601
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: