Healthcare Provider Details

I. General information

NPI: 1902235120
Provider Name (Legal Business Name): VANESSA THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2013
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3731 NE 217TH CT
WILLISTON FL
32696-7048
US

IV. Provider business mailing address

3731 NE 217TH CT
WILLISTON FL
32696-7048
US

V. Phone/Fax

Practice location:
  • Phone: 352-528-3362
  • Fax: 352-528-0180
Mailing address:
  • Phone: 352-528-3362
  • Fax: 352-528-0180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number6906181
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number6906181
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: