Provider Demographics
NPI:1760018683
Name:THOMAS, KEILA ANNETTE (RN)
Entity Type:Individual
Prefix:MISS
First Name:KEILA
Middle Name:ANNETTE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KEILA
Other - Middle Name:ANNETTE
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:KEILATHOMAS
Mailing Address - Street 2:5579 NW COMMODORE TERRACE
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983
Mailing Address - Country:US
Mailing Address - Phone:772-631-4518
Mailing Address - Fax:
Practice Address - Street 1:5579 NW COMMODORE TER
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-2304
Practice Address - Country:US
Practice Address - Phone:772-631-4518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9216469163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty