Provider Demographics
NPI:1093888224
Name:THOMAS, MEREDITH LEIGH (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MEREDITH
Middle Name:LEIGH
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1350 HICKORY ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3224
Practice Address - Country:US
Practice Address - Phone:321-434-1401
Practice Address - Fax:321-434-1667
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232558363AM0700X
TXPA04975363AS0400X
FLPA9115907363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX208057402Medicaid
VA208057401Medicaid
TXD07564OtherMEDICARE RR PALMETTO
TXTXB149935OtherPROVIDER TRANSACTION ACCESS NUMBER (PTAN)
TX327288YV3COtherMEDICARE PTAN
TX891N49OtherBCBS
TX273899YPWZOtherMEDICARE GROUP PTAN
FLQU188OtherHFPSI
TXDQ5280OtherMEDICARE RR PALMETTO
FLQU189OtherHFMG
FL117865200Medicaid
TX208057402Medicaid