Healthcare Provider Details

I. General information

NPI: 1801856539
Provider Name (Legal Business Name): THOMAS FRANCIS FLYNN ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 PRUDENTIAL DR
JACKSONVILLE FL
32207-8202
US

IV. Provider business mailing address

2586 CATAWBA RIDGE CT
ORANGE PARK FL
32065-8905
US

V. Phone/Fax

Practice location:
  • Phone: 904-202-3066
  • Fax:
Mailing address:
  • Phone: 904-276-7070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP898082
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: