Healthcare Provider Details

I. General information

NPI: 1063453280
Provider Name (Legal Business Name): MAUREEN MCDONALD THOMAS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7152 COCA SABAL LN # 77
FORT MYERS FL
33908-4263
US

IV. Provider business mailing address

1650 HUNTINGDON PIKE SUITE 313
MEADOWBROOK PA
19046-8004
US

V. Phone/Fax

Practice location:
  • Phone: 239-985-0215
  • Fax:
Mailing address:
  • Phone: 215-938-3413
  • Fax: 215-938-3422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN275248L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11022001
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: