Provider Demographics
NPI:1508480229
Name:THANGA, RITA W
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:W
Last Name:THANGA
Suffix:
Gender:F
Credentials:
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 748519
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-8519
Mailing Address - Country:US
Mailing Address - Phone:904-376-3800
Mailing Address - Fax:904-376-3998
Practice Address - Street 1:1660 PRUDENTIAL DR STE 410
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8197
Practice Address - Country:US
Practice Address - Phone:904-376-3800
Practice Address - Fax:904-390-7401
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-29
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FLRN9339312163WP0809X
FLAPRN11009359363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult