Healthcare Provider Details

I. General information

NPI: 1396977419
Provider Name (Legal Business Name): JANALEA KRISTIN THOMAS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2009
Last Update Date: 08/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9776 BONITA BEACH RD SE SUITE 102
BONITA SPRINGS FL
34135-4773
US

IV. Provider business mailing address

PO BOX 166321
MIAMI FL
33116-6321
US

V. Phone/Fax

Practice location:
  • Phone: 239-949-1777
  • Fax: 239-498-3777
Mailing address:
  • Phone: 239-949-1777
  • Fax: 239-498-3777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA3342
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: