MEDICARE: MISTI DAWN THOMAS

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	363L00000X	Nurse Practitioner	APRN9294232	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134695547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISTI DAWN THOMAS

Provider Business Mailing Address
First Line	:	1737 SHERWOOD LAKES BLVD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33809-6809
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1737 SHERWOOD LAKES BLVD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33809-6809
Country	:	US
Telephone Number	:	863-286-4280
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2018
Last Update Date	:	11/04/2020

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Directions to “ MISTI DAWN THOMAS ” Practice Location

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