Provider Demographics
NPI:1265464457
Name:THOMAS, JACQUELINE FRANCINE (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:FRANCINE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 N BAYOU ST
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36603-5827
Mailing Address - Country:US
Mailing Address - Phone:251-690-8158
Mailing Address - Fax:251-544-2188
Practice Address - Street 1:251 N BAYOU ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36603-5827
Practice Address - Country:US
Practice Address - Phone:251-690-8158
Practice Address - Fax:251-544-2188
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1057416363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
51037809OtherBLUE CROSS BLUE SHIELD
AL011846OtherMAIN GROUP MEDICARE PAYEE NUMBER
AL1063439065OtherMAIN GROUP NPI PAYEE NUMBER
AL630000013Medicaid
AL630101018Medicaid
AL1063439065OtherMAIN GROUP NPI PAYEE NUMBER
AL630000013Medicaid