Provider Demographics
NPI:1225786114
Name:THOMAS, TERRAINIE L (CERTIFIED DOULA)
Entity Type:Individual
Prefix:
First Name:TERRAINIE
Middle Name:L
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CERTIFIED DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3906 CONNECTICUT AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-5641
Mailing Address - Country:US
Mailing Address - Phone:904-290-3936
Mailing Address - Fax:
Practice Address - Street 1:3906 CONNECTICUT AVE
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-5641
Practice Address - Country:US
Practice Address - Phone:904-290-3936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT523812779230OtherCERTIFIED DOULA