Healthcare Provider Details

I. General information

NPI: 1427019876
Provider Name (Legal Business Name): CHARITY J. THOMASOS M.S., R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 BOATNER RD SUITE 144
EGLIN AFB FL
32542-1391
US

IV. Provider business mailing address

119A BIRCH CIR
EGLIN AFB FL
32542-1288
US

V. Phone/Fax

Practice location:
  • Phone: 850-883-9185
  • Fax:
Mailing address:
  • Phone: 850-883-9185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND 2539
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: