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General NPI Number Information
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NPI Number | 1750467833
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Entity Type | Individual
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Provider Name | NANCY JACKSON THOMAS PHD
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Gender | Female
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 08/08/2007
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Provider Practice Location Address
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Address Line | 13000 SAWGRASS VILLAGE CIR STE 11
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City | PONTE VEDRA
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State | FL
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Zip | 32082-3078
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Country | US
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Telephone | 904-280-8555
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Fax | 904-280-8562
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Provider Business Mailing Address
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Address Line | 4650 SWILCAN BRIDGE LN S
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City | JACKSONVILLE
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State | FL
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Zip | 32224-5620
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Country | US
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Telephone | 904-280-8555
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Fax | 904-280-8562
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY0003951
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License Number State | FL
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