Provider Demographics
NPI:1598785586
Name:THOMPSON, PATRICIA RUTH (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:RUTH
Last Name:THOMPSON
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 1:12050 E COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32826-4705
Mailing Address - Country:US
Mailing Address - Phone:407-249-6232
Mailing Address - Fax:407-249-4456
Practice Address - Street 1:12050 E COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-4705
Practice Address - Country:US
Practice Address - Phone:407-249-6232
Practice Address - Fax:407-249-4456
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP371252363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0333018Medicaid
FLFG961ZMedicare PIN
FLY5228YMedicare PIN
FLY52282Medicare ID - Type Unspecified
FLS05641Medicare UPIN
FL505641Medicare UPIN
FLY52284Medicare PIN