Provider Demographics
NPI:1699176719
Name:THOMPSON-RILEY, CAROL
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:THOMPSON-RILEY
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 1:3325 THOMASVILLE RD STE A
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-7970
Mailing Address - Country:US
Mailing Address - Phone:850-296-5662
Mailing Address - Fax:850-765-2848
Practice Address - Street 1:3325 THOMASVILLE RD STE A
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-7970
Practice Address - Country:US
Practice Address - Phone:850-296-5662
Practice Address - Fax:850-765-2848
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1136062003747A0650X
374U00000X
FL233569253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No253Z00000XAgenciesIn Home Supportive Care