Provider Demographics
NPI:1487645578
Name:THOMAS, ELLEN NADINE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:NADINE
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:PO BOX 16568
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32245-6568
Mailing Address - Country:US
Mailing Address - Phone:904-472-2300
Mailing Address - Fax:904-472-2330
Practice Address - Street 1:6879 SOUTHPOINT DR N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6179
Practice Address - Country:US
Practice Address - Phone:904-296-2441
Practice Address - Fax:904-821-3113
Is Sole Proprietor?:No
Enumeration Date:2005-10-29
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1763212363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL305499300Medicaid
FLY8429OtherBLUECROSS/BLUESHIELD
FL500011594OtherRAILROAD MEDICARE
FL500011594OtherRAILROAD MEDICARE
FL305499300Medicaid