Provider Demographics
NPI:1003574856
Name:THOMAS, JEWELL
Entity Type:Individual
Prefix:
First Name:JEWELL
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1831 13TH AVE E APT 1104
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-8309
Mailing Address - Country:US
Mailing Address - Phone:941-544-4214
Mailing Address - Fax:
Practice Address - Street 1:2137 BANNEKER WAY
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34234-6304
Practice Address - Country:US
Practice Address - Phone:941-544-4214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide