Healthcare Provider Details

I. General information

NPI: 1992173157
Provider Name (Legal Business Name): JESSIE THOMAS APRN, FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2015
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 N US HIGHWAY 441
THE VILLAGES FL
32159-8975
US

IV. Provider business mailing address

4545 SE 30TH CT
OCALA FL
34480-7274
US

V. Phone/Fax

Practice location:
  • Phone: 352-751-2862
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9486070
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: