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General NPI Number Information
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NPI Number | 1386239606
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Entity Type | Individual
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Provider Name | JENNA THOMAS FNP
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Gender | Female
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Dates
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Enumeration Date | 03/08/2021
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Last Update Date | 05/12/2022
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Provider Practice Location Address
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Address Line | 21298 OLEAN BLVD
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-6705
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Country | US
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Telephone | 941-624-8719
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Fax |
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Provider Business Mailing Address
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Address Line | 1001 SW 34TH TER
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City | CAPE CORAL
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State | FL
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Zip | 33914-5216
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Country | US
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Telephone | 262-573-0617
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN11010297
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11010297
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License Number State | FL
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