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General NPI Number Information
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NPI Number | 1457652414
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Entity Type | Individual
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Provider Name | MICHELLE NANCY THOMSEN PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/08/2010
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Last Update Date | 01/03/2025
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Provider Practice Location Address
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Address Line | 10065 CORTEZ BLVD
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City | WEEKI WACHEE
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State | FL
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Zip | 34613-6389
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Country | US
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Telephone | 352-596-4660
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Fax | 352-596-4674
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Provider Business Mailing Address
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Address Line | 19608 WHISPERING FERN PL
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City | LUTZ
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State | FL
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Zip | 33558-1902
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Country | US
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Telephone |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA21096
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License Number State | CA
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