Provider Demographics
NPI:1477697944
Name:THOMPSON, MARCIA S (RN)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:S
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5170 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:FL
Mailing Address - Zip Code:32445-3426
Mailing Address - Country:US
Mailing Address - Phone:850-569-1197
Mailing Address - Fax:850-569-5556
Practice Address - Street 1:5170 12TH AVE
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:FL
Practice Address - Zip Code:32445-3426
Practice Address - Country:US
Practice Address - Phone:850-569-1197
Practice Address - Fax:850-569-5556
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3076242163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health