MEDICARE: MRS. CLARABELL PHILISTINA THOMPSON NURSE PRACTITIONER

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	363LA2200X	Adult Health Nurse Practitioner	2514492	FL

General Provider Information

NPI Number	:	1699112888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CLARABELL PHILISTINA THOMPSON NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	6300 NE 2ND AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33138-6005
Country	:	US
Telephone Number	:	305-754-8966
Fax Number	:

Provider Business Practice Location Address
First Line	:	6300 NE 2ND AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33138-6005
Country	:	US
Telephone Number	:	305-754-8966
Fax Number	:

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

Provider Enumeration Date	:	05/28/2013
Last Update Date	:	05/28/2013

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