MEDICARE: ELSA 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	363LF0000X	Family Nurse Practitioner	11021048	FL

General Provider Information

NPI Number	:	1376271114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELSA THOMAS

Provider Business Mailing Address
First Line	:	11646 HIBBS GROVE DR
Second Line	:
City	:	COOPER CITY
State	:	FL
Zip	:	33330-8803
Country	:	US
Telephone Number	:	954-770-5270
Fax Number	:

Provider Business Practice Location Address
First Line	:	11646 HIBBS GROVE DR
Second Line	:
City	:	COOPER CITY
State	:	FL
Zip	:	33330-8803
Country	:	US
Telephone Number	:	954-770-5270
Fax Number	:

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

Provider Enumeration Date	:	08/10/2022
Last Update Date	:	08/10/2022

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Directions to “ ELSA THOMAS ” Practice Location

Language	Start Address	Practice Location

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