Provider Demographics
NPI:1376630384
Name:THOMAS, VICKIE L (ARNP)
Entity Type:Individual
Prefix:
First Name:VICKIE
Middle Name:L
Last Name:THOMAS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15544 W COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-9556
Mailing Address - Country:US
Mailing Address - Phone:800-457-4573
Mailing Address - Fax:800-443-6422
Practice Address - Street 1:11531 W EMERALD OAKS DR
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34428-2815
Practice Address - Country:US
Practice Address - Phone:800-457-4573
Practice Address - Fax:800-443-6422
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5205P363LP0808X
WV67306363LP0808X
FLAPRN11029721363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30610026Medicaid
P00408776OtherPALMETTA RR MCR
000000502370OtherANTHEM BCBS
1982615043OtherGROUP NPI
1982615043OtherGROUP NPI