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General NPI Number Information
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NPI Number | 1972092310
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Entity Type | Individual
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Provider Name | SHEQUILA THOMAS LPN
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Gender | Female
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Dates
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Enumeration Date | 05/01/2018
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Last Update Date | 05/01/2018
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Provider Practice Location Address
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Address Line | 14091 SUMMER BREEZE DR E
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City | JACKSONVILLE
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State | FL
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Zip | 32218-8913
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Country | US
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Telephone | 804-502-5840
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Fax | 904-485-8541
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Provider Business Mailing Address
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Address Line | 1306 MARK CT
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City | APOPKA
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State | FL
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Zip | 32703-6939
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Country | US
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Telephone | 407-797-2435
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | PN5218517
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License Number State | FL
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