Healthcare Provider Details

I. General information

NPI: 1700495660
Provider Name (Legal Business Name): KRISTEN-ANNE THOMAS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2020
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 S PARK AVE STE 3
SANFORD FL
32771-1246
US

IV. Provider business mailing address

2617 NEVERLAND DR
NEW SMYRNA BEACH FL
32168-2490
US

V. Phone/Fax

Practice location:
  • Phone: 407-534-9178
  • Fax:
Mailing address:
  • Phone: 954-319-4922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11006301
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: