Provider Demographics
NPI:1245570324
Name:THOMPSON, MICHAEL JOEL (RPA-C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOEL
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 STATE ROAD 44
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-7271
Mailing Address - Country:US
Mailing Address - Phone:386-423-2550
Mailing Address - Fax:386-423-2525
Practice Address - Street 1:845 STATE ROAD 44
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-7271
Practice Address - Country:US
Practice Address - Phone:386-423-2550
Practice Address - Fax:386-423-2525
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-26
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY016442363A00000X
FLPA9112386363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant