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General NPI Number Information
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NPI Number | 1114581907
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Entity Type | Individual
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Provider Name | MRS. KAIDRA QUANTAI THONPKINS
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Gender | Female
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Dates
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Enumeration Date | 04/26/2019
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Last Update Date | 04/26/2019
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Provider Practice Location Address
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Address Line | 118 THISTLE TRL
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City | HAWTHONRE
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State | FL
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Zip | 32604
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Country | US
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Telephone | 352-301-1271
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Fax |
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Provider Business Mailing Address
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Address Line | 118 THISTLE TRL
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City | HAWTHORNE
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State | FL
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Zip | 32640-5810
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Country | US
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Telephone | 352-301-1271
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number | L19000048624
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License Number State | FL
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