Healthcare Provider Details

I. General information

NPI: 1730405234
Provider Name (Legal Business Name): JEANETTE THOMPSON RN, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2010
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

558 RHEINE RD NW
PALM BAY FL
32907-1044
US

IV. Provider business mailing address

558 RHEINE RD NW
PALM BAY FL
32907-1044
US

V. Phone/Fax

Practice location:
  • Phone: 321-213-5531
  • Fax:
Mailing address:
  • Phone: 321-213-5531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9175115
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN9175115
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number13830
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: