Provider Demographics
NPI:1629732912
Name:THOMAS, KATRINA D (BUSINESS/ OPERATOR)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:D
Last Name:THOMAS
Suffix:
Gender:F
Credentials:BUSINESS/ OPERATOR
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:D
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:50 N LAURA ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32202-3664
Mailing Address - Country:US
Mailing Address - Phone:904-775-0187
Mailing Address - Fax:
Practice Address - Street 1:50 N LAURA ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32202-3664
Practice Address - Country:US
Practice Address - Phone:904-775-0187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-24
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL305567251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL861419800OtherHOMEMAKER AND COMPANION