=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588176010
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOAN HERMITT THOMPSON
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2017
-----------------------------------------------------
Last Update Date | 10/24/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3241 TURTLE CV
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33411-6471
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-325-0278
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3241 TURTLE CV
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33411-6471
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-325-0278
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JOAN HERMITT THOMPSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 904-325-0278
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 376J00000X
-----------------------------------------------------
Taxonomy Name | Homemaker
-----------------------------------------------------
License Number | 235057
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------