=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699074609
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THOMPSON VANHYNING JR. PA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/17/2011
-----------------------------------------------------
Last Update Date | 07/05/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1918 SE 17TH ST SUITE 300
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34471-4120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-620-2420
-----------------------------------------------------
Fax | 352-620-2935
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2600 LAKE LUCIEN DR SUITE 180
-----------------------------------------------------
City | MAITLAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32751-7233
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-875-2080
-----------------------------------------------------
Fax | 407-875-0518
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA9105899
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------