Healthcare Provider Details

I. General information

NPI: 1982166997
Provider Name (Legal Business Name): JENY THOMAS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 LAKELAND HILLS BLVD STE 4
LAKELAND FL
33805-3257
US

IV. Provider business mailing address

27 THE VILLAGE BLVD
WINTER HAVEN FL
33880-1645
US

V. Phone/Fax

Practice location:
  • Phone: 863-937-7157
  • Fax: 863-333-0260
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11000766
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: