Healthcare Provider Details

I. General information

NPI: 1154655710
Provider Name (Legal Business Name): THOMAS E PARKS P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2009
Last Update Date: 03/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10461 QUALITY DR
SPRING HILL FL
34609-9634
US

IV. Provider business mailing address

1810 E PALM AVE APT 1117
TAMPA FL
33605-3938
US

V. Phone/Fax

Practice location:
  • Phone: 352-688-3002
  • Fax:
Mailing address:
  • Phone: 954-816-5059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: