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General NPI Number Information
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NPI Number | 1740518430
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Entity Type | Individual
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Provider Name | JACQUELINE THOMAS D.O.
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Gender | Female
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Dates
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Enumeration Date | 11/18/2009
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Last Update Date | 01/25/2024
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Provider Practice Location Address
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Address Line | 3200 S UNIVERSITY DR SUITE 4345 ZIFF BUILDING
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City | DAVIE
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State | FL
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Zip | 33328-2018
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Country | US
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Telephone | 954-262-1647
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Fax | 954-262-3981
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Provider Business Mailing Address
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Address Line | 13800 TAMIAMI TRL N STE 112
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City | NAPLES
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State | FL
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Zip | 34110-6204
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Country | US
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Telephone | 239-500-7546
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Fax | 239-294-8125
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | OS 9917
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License Number State | FL
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