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General NPI Number Information
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NPI Number | 1679174668
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Entity Type | Individual
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Provider Name | AMANDA L THOMAS
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Gender | Female
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Dates
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Enumeration Date | 11/05/2020
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Last Update Date | 11/05/2020
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Provider Practice Location Address
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Address Line | 50 N LAURA ST STE 2500
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City | JACKSONVILLE
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State | FL
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Zip | 32202-3220
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Country | US
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Telephone | 904-478-8300
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Fax | 904-478-8301
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Provider Business Mailing Address
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Address Line | PO BOX 65458
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City | ORANGE PARK
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State | FL
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Zip | 32065-0008
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Country | US
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Telephone | 850-225-9494
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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 | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 236816
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License Number State | FL
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