Provider Demographics
NPI:1134670912
Name:THOMAS, VIVIAN CAROLINA (DNP, MSN, APRN, PMHN)
Entity Type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:CAROLINA
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DNP, MSN, APRN, PMHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21300 RUTH AND BARON COLEMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-1757
Mailing Address - Country:US
Mailing Address - Phone:561-852-3333
Mailing Address - Fax:561-852-3156
Practice Address - Street 1:21300 RUTH AND BARON COLEMAN BLVD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-1757
Practice Address - Country:US
Practice Address - Phone:561-852-3333
Practice Address - Fax:561-852-3156
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-17
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9259564363LA2100X
FLAPRN9259564363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care