Healthcare Provider Details

I. General information

NPI: 1235747924
Provider Name (Legal Business Name): CECILIA ASHLEY THOMAS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2020
Last Update Date: 07/19/2020
Certification Date: 07/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 PRUDENTIAL DR
JACKSONVILLE FL
32207-8202
US

IV. Provider business mailing address

1095 RATCLIFFE LAKE DR
BRUNSWICK GA
31523-5601
US

V. Phone/Fax

Practice location:
  • Phone: 904-202-2000
  • Fax:
Mailing address:
  • Phone: 912-270-0931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN258536
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: