Healthcare Provider Details

I. General information

NPI: 1245703826
Provider Name (Legal Business Name): SARAMMA THOMAS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2019
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2906 17TH ST
SAINT CLOUD FL
34769-6006
US

IV. Provider business mailing address

2906 17TH ST
SAINT CLOUD FL
34769-6006
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-6444
  • Fax: 407-891-2941
Mailing address:
  • Phone: 321-841-6444
  • Fax: 407-891-2941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11000533
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11000533
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11000533
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: