Healthcare Provider Details

I. General information

NPI: 1104124064
Provider Name (Legal Business Name): MELISSA S THOMAS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2011
Last Update Date: 12/18/2019
Certification Date: 12/18/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 SHIRCLIFF WAY STE 435
JACKSONVILLE FL
32204
US

IV. Provider business mailing address

4205 BELFORT RD STE 4015
JACKSONVILLE FL
32216-3623
US

V. Phone/Fax

Practice location:
  • Phone: 904-308-6900
  • Fax: 904-308-6927
Mailing address:
  • Phone: 904-296-5691
  • Fax: 904-450-6401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN3394912
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP3394912
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: