Provider Demographics
NPI:1003065509
Name:THOMAS, NICOLE (APRN)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1891 BEACH BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-2644
Mailing Address - Country:US
Mailing Address - Phone:904-249-3743
Mailing Address - Fax:904-249-2047
Practice Address - Street 1:1891 BEACH BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-2644
Practice Address - Country:US
Practice Address - Phone:904-249-3743
Practice Address - Fax:904-249-2047
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9181882363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner