Healthcare Provider Details

I. General information

NPI: 1467397760
Provider Name (Legal Business Name): EFIA EMMILA THOMPSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 US HIGHWAY 301 N
ELLENTON FL
34222-2828
US

IV. Provider business mailing address

5005 US HIGHWAY 301 N
ELLENTON FL
34222-2828
US

V. Phone/Fax

Practice location:
  • Phone: 941-209-9940
  • Fax:
Mailing address:
  • Phone: 941-941-9940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number289636
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: