Healthcare Provider Details

I. General information

NPI: 1972479301
Provider Name (Legal Business Name): ANGEL THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2025
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

292 SILVER GLEN AVE
ST AUGUSTINE FL
32092-2470
US

IV. Provider business mailing address

292 SILVER GLEN AVE
ST AUGUSTINE FL
32092-2470
US

V. Phone/Fax

Practice location:
  • Phone: 904-226-6953
  • Fax:
Mailing address:
  • Phone: 904-227-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: