Provider Demographics
NPI:1073519245
Name:THOMPSON, CAROL S (CNM)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:S
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:13110 ELK MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-7182
Mailing Address - Country:US
Mailing Address - Phone:813-349-7569
Mailing Address - Fax:813-349-7569
Practice Address - Street 1:508 N MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-3820
Practice Address - Country:US
Practice Address - Phone:813-349-7600
Practice Address - Fax:813-938-6423
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1957232367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL033792700Medicaid
FL033792700Medicaid