Healthcare Provider Details

I. General information

NPI: 1275558744
Provider Name (Legal Business Name): ABIGAIL GRACE THORN ARNP CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 06/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 OVEN PARK DRIVE SUITE 201
TALLAHASSEE FL
32308
US

IV. Provider business mailing address

PO BOX 15399
TALLAHASSEE FL
32317-5399
US

V. Phone/Fax

Practice location:
  • Phone: 850-765-8623
  • Fax: 850-765-0118
Mailing address:
  • Phone: 850-765-8623
  • Fax: 850-765-0118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberARNP2749192
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP2749192
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: