Provider Demographics
NPI:1801358163
Name:THOMAS, WILLIAM WAYNE II (APRN-FPA, FNP-C)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:WAYNE
Last Name:THOMAS
Suffix:II
Gender:M
Credentials:APRN-FPA, FNP-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-858-6377
Mailing Address - Fax:239-319-2194
Practice Address - Street 1:9520 BONITA BEACH RD SE
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-4517
Practice Address - Country:US
Practice Address - Phone:239-319-2195
Practice Address - Fax:239-319-2194
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277000948363L00000X
KY3013324363LF0000X
IL209.019260363LF0000X
FLAPRN11027868363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL214881OtherMULTI SPECIALTY PTAN
IL209.019260Medicaid