Provider Demographics
NPI:1609348309
Name:THOMAS, MINI (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:MINI
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:971 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-4545
Mailing Address - Country:US
Mailing Address - Phone:516-770-1136
Mailing Address - Fax:
Practice Address - Street 1:971 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-4545
Practice Address - Country:US
Practice Address - Phone:516-770-1136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF343311-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily