Healthcare Provider Details

I. General information

NPI: 1477697944
Provider Name (Legal Business Name): MARCIA S THOMPSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5170 12TH AVE
MALONE FL
32445-3426
US

IV. Provider business mailing address

5170 12TH AVE
MALONE FL
32445-3426
US

V. Phone/Fax

Practice location:
  • Phone: 850-569-1197
  • Fax: 850-569-5556
Mailing address:
  • Phone: 850-569-1197
  • Fax: 850-569-5556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number3076242
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: