Healthcare Provider Details

I. General information

NPI: 1932985801
Provider Name (Legal Business Name): THOMAS CHAD MCDANNEL MSN, APRN, FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2023
Last Update Date: 09/08/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SUNNY ISLES SHOPPING CENTER SPACES 1, 2, AND 3A
CHRISTIANSTED VI
00820
US

IV. Provider business mailing address

1839 CENTRAL AVE
ST PETERSBURG FL
33713-8900
US

V. Phone/Fax

Practice location:
  • Phone: 340-202-0084
  • Fax:
Mailing address:
  • Phone: 727-322-1054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11028398
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200520
License Number StateVI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: