Healthcare Provider Details

I. General information

NPI: 1679566558
Provider Name (Legal Business Name): THOMAS R MOHAN ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 SW 20TH PL STE 100
OCALA FL
34471-7881
US

IV. Provider business mailing address

1920 SW 20TH PL STE 100
OCALA FL
34471-7881
US

V. Phone/Fax

Practice location:
  • Phone: 352-237-1212
  • Fax: 352-237-0066
Mailing address:
  • Phone: 352-237-1212
  • Fax: 352-237-0066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP3386112
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: