Provider Demographics
NPI:1023580248
Name:THOMAS, KAYOTRIS TIJUAN
Entity Type:Individual
Prefix:
First Name:KAYOTRIS
Middle Name:TIJUAN
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 1:80 MAKAYLA LN
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:FL
Mailing Address - Zip Code:32352-3200
Mailing Address - Country:US
Mailing Address - Phone:850-567-8928
Mailing Address - Fax:
Practice Address - Street 1:80 MAKAYLA LN
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:FL
Practice Address - Zip Code:32352-3200
Practice Address - Country:US
Practice Address - Phone:850-567-8928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-28
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care