Provider Demographics
NPI:1427371632
Name:THOMAS, TAWANA I (MD)
Entity Type:Individual
Prefix:DR
First Name:TAWANA
Middle Name:I
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TAWANA
Other - Middle Name:I
Other - Last Name:MCNAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2122 UNIVERSITY BLVD S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-8937
Mailing Address - Country:US
Mailing Address - Phone:904-398-5614
Mailing Address - Fax:904-398-5617
Practice Address - Street 1:2122 UNIVERSITY BLVD S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-8937
Practice Address - Country:US
Practice Address - Phone:904-398-5614
Practice Address - Fax:904-398-5617
Is Sole Proprietor?:No
Enumeration Date:2010-03-03
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME120042207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHV632ZMedicare PIN