Provider Demographics
NPI:1114995883
Name:THOMAS, SANDRA LEAH (RN)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:LEAH
Last Name:THOMAS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 FLAMINGO DR
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-8490
Mailing Address - Country:US
Mailing Address - Phone:386-446-4969
Mailing Address - Fax:386-446-4969
Practice Address - Street 1:3127 W INTERNATIONAL SPEEDWAY BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32124-1070
Practice Address - Country:US
Practice Address - Phone:386-258-9502
Practice Address - Fax:386-239-9781
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9194794163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL79517Medicare ID - Type Unspecified
FLD67306Medicare UPIN