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NPI Code Detail

MEDICARE: ADALINE SULLIVAN THOMAS ARNP

MEDICARE: ADALINE SULLIVAN THOMAS ARNP
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
1363LP0200XPediatric Nurse PractitionerARNP 1379282FL

General Provider Information

NPI Number : 1295734143
Entity Type Code : Individual
Provider Name (Legal Business Name) : ADALINE SULLIVAN THOMAS ARNP
Provider Business Mailing Address
First Line : 1051 GOLFSIDE DR
Second Line :
City : WINTER PARK
State : FL
Zip : 32792-5127
Country : US
Telephone Number : 407-677-7047
Fax Number :
Provider Business Practice Location Address
First Line : 618 S FOREST AVE
Second Line :
City : APOPKA
State : FL
Zip : 32703-5338
Country : US
Telephone Number : 407-886-6201
Fax Number : 407-886-3822
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2005
Last Update Date : 07/08/2007

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