Healthcare Provider Details

I. General information

NPI: 1962333690
Provider Name (Legal Business Name): TINA MARIE THOMPSON PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20202 W. PENSACOLA ST STE 210-164
TALLAHASSEE FL
32304
US

IV. Provider business mailing address

20202 W. PENSACOLA ST STE 210 164
TALLAHASSEE FL
32304
US

V. Phone/Fax

Practice location:
  • Phone: 215-839-5048
  • Fax:
Mailing address:
  • Phone: 215-839-5048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11047359
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: