=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841264058
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARAH ELLEN THOMAS FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2006
-----------------------------------------------------
Last Update Date | 01/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3140 SUNTREE BLVD STE 5
-----------------------------------------------------
City | ROCKLEDGE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32955-5789
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-985-4200
-----------------------------------------------------
Fax | 321-622-4062
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 166 WILLOW TRL
-----------------------------------------------------
City | BOONE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28607-7085
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-265-4516
-----------------------------------------------------
Fax | 828-262-6262
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | APRN11013763
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------