Healthcare Provider Details

I. General information

NPI: 1457652414
Provider Name (Legal Business Name): MICHELLE NANCY THOMSEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2010
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10065 CORTEZ BLVD
WEEKI WACHEE FL
34613-6389
US

IV. Provider business mailing address

19608 WHISPERING FERN PL
LUTZ FL
33558-1902
US

V. Phone/Fax

Practice location:
  • Phone: 352-596-4660
  • Fax: 352-596-4674
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA21096
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: