Provider Demographics
NPI:1326005844
Name:ST THOMAS, CLARA E (NP)
Entity Type:Individual
Prefix:MRS
First Name:CLARA
Middle Name:E
Last Name:ST THOMAS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19111 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-6014
Mailing Address - Country:US
Mailing Address - Phone:954-885-8108
Mailing Address - Fax:
Practice Address - Street 1:12401 MIRAMAR PKWY
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-2900
Practice Address - Country:US
Practice Address - Phone:954-538-8473
Practice Address - Fax:954-538-8479
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND1125133V00000X
FLARNP9248728363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8108439-00Medicaid
FLN0104Medicare ID - Type Unspecified
FLAJ569ZMedicare PIN