Provider Demographics
NPI:1043260946
Name:THOMAS, NICOLE BRIGETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:BRIGETTE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NICOLE
Other - Middle Name:BRIGETTE
Other - Last Name:THOMAS-HUNTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 9101
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33419-9101
Mailing Address - Country:US
Mailing Address - Phone:561-633-9871
Mailing Address - Fax:
Practice Address - Street 1:VA MEDICAL CENTER, 7305 N. MILITARY TRAIL
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FLORIDA
Practice Address - Zip Code:33410
Practice Address - Country:UM
Practice Address - Phone:561-633-9871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0061430207R00000X, 208M00000X
GA060479207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL371924300Medicaid
FL14665OtherMEDICARE
FL371924300Medicaid