=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306657929
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHERELLE A THOMAS CPT1
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/14/2025
-----------------------------------------------------
Last Update Date | 01/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1333 COLLEGE PKWY # 622
-----------------------------------------------------
City | GULF BREEZE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32563-2711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-447-6279
-----------------------------------------------------
Fax | 972-767-3970
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1333 COLLEGE PKWY # 622
-----------------------------------------------------
City | GULF BREEZE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32563-2711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-447-6279
-----------------------------------------------------
Fax | 972-767-3970
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 246RP1900X
-----------------------------------------------------
Taxonomy Name | Phlebotomy Technician
-----------------------------------------------------
License Number | CPT-00069262
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------