Healthcare Provider Details

I. General information

NPI: 1760559330
Provider Name (Legal Business Name): JOHN I THOMPSON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 08/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 BELFORT RD
JACKSONVILLE FL
32256-6004
US

IV. Provider business mailing address

4800 BELFORT RD
JACKSONVILLE FL
32256-6004
US

V. Phone/Fax

Practice location:
  • Phone: 904-265-4801
  • Fax: 904-265-6458
Mailing address:
  • Phone: 904-483-5850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9317794
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: