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General NPI Number Information
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NPI Number | 1497590103
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Entity Type | Individual
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Provider Name | CONSUELO TOMAS
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Gender | Female
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Dates
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Enumeration Date | 06/26/2024
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Last Update Date | 12/14/2024
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Provider Practice Location Address
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Address Line | 4190 BELFORT RD STE 140
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City | JACKSONVILLE
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State | FL
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Zip | 32216-5871
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Country | US
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Telephone | 904-296-2999
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Fax |
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Provider Business Mailing Address
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Address Line | 13453 N MAIN ST STE 104
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City | JACKSONVILLE
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State | FL
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Zip | 32218-2773
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 11033619
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License Number State | FL
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