Healthcare Provider Details

I. General information

NPI: 1245859305
Provider Name (Legal Business Name): DEVON NICOLE THOMAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2020
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 WATERMAN WAY
TAVARES FL
32778-5229
US

IV. Provider business mailing address

12109 COUNTY ROAD 103
OXFORD FL
34484-2951
US

V. Phone/Fax

Practice location:
  • Phone: 352-343-2364
  • Fax: 352-253-0022
Mailing address:
  • Phone: 352-205-8981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberME172077
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: