Provider Demographics
NPI:1477966521
Name:THOMAS, GIDGETTA (LPN)
Entity Type:Individual
Prefix:
First Name:GIDGETTA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12832 NW CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:FL
Mailing Address - Zip Code:32321-6918
Mailing Address - Country:US
Mailing Address - Phone:850-643-2292
Mailing Address - Fax:850-643-2309
Practice Address - Street 1:12832 NW CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:FL
Practice Address - Zip Code:32321-6918
Practice Address - Country:US
Practice Address - Phone:850-643-2292
Practice Address - Fax:850-643-2309
Is Sole Proprietor?:No
Enumeration Date:2014-06-06
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN1240931164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse