Provider Demographics
NPI:1013647452
Name:THOMAS, TANASIA CHICOLE (MPH, MSN, APRN-C)
Entity Type:Individual
Prefix:
First Name:TANASIA
Middle Name:CHICOLE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MPH, MSN, APRN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7155 CHATUM LIGHT RUN
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34212-7012
Mailing Address - Country:US
Mailing Address - Phone:941-580-2890
Mailing Address - Fax:
Practice Address - Street 1:7155 CHATUM LIGHT RUN
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34212-7012
Practice Address - Country:US
Practice Address - Phone:941-580-2890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-16
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11020179363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily