Provider Demographics
NPI:1114581907
Name:THONPKINS, KAIDRA QUANTAI
Entity Type:Individual
Prefix:MRS
First Name:KAIDRA
Middle Name:QUANTAI
Last Name:THONPKINS
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 1:118 THISTLE TRL
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:FL
Mailing Address - Zip Code:32640-5810
Mailing Address - Country:US
Mailing Address - Phone:352-301-1271
Mailing Address - Fax:
Practice Address - Street 1:118 THISTLE TRL
Practice Address - Street 2:
Practice Address - City:HAWTHONRE
Practice Address - State:FL
Practice Address - Zip Code:32604
Practice Address - Country:US
Practice Address - Phone:352-301-1271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-26
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL19000048624385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child