MEDICARE: THOMAS A. TOMLIN M.D. PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1033430871
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMAS A. TOMLIN M.D. PA

Provider Business Mailing Address
First Line	:	3948 3RD ST S # 384
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-5847
Country	:	US
Telephone Number	:	904-285-9355
Fax Number	:	904-285-7442

Provider Business Practice Location Address
First Line	:	1100 SAWGRASS VILLAGE DR
Second Line	:	SUITE 100
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-5048
Country	:	US
Telephone Number	:	904-285-9355
Fax Number	:	904-285-7442

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	MR. THOMAS A. TOMLIN
Credential	:	M.D.
Telephone Number	:	904-285-9355

Provider Enumeration Date	:	06/16/2010
Last Update Date	:	06/16/2010

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