Provider Demographics
NPI:1235397944
Name:THOMPSON, MELBA JEAN (RN)
Entity Type:Individual
Prefix:MRS
First Name:MELBA
Middle Name:JEAN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 PARK ST N
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-4030
Mailing Address - Country:US
Mailing Address - Phone:727-345-8614
Mailing Address - Fax:727-345-9319
Practice Address - Street 1:4020 PARK ST N
Practice Address - Street 2:SUITE 103
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-4030
Practice Address - Country:US
Practice Address - Phone:727-345-8614
Practice Address - Fax:727-345-9319
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN931622163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRN931622OtherSTATE OF FLORIDA REGISTERED NURSE