Provider Demographics
NPI:1861859183
Name:THOMPSON NEMBHARD, SKEETER (APRN)
Entity Type:Individual
Prefix:
First Name:SKEETER
Middle Name:
Last Name:THOMPSON NEMBHARD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 W STATE ROAD 434 STE 1004
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-4969
Mailing Address - Country:US
Mailing Address - Phone:407-732-5753
Mailing Address - Fax:
Practice Address - Street 1:1250 W STATE ROAD 434 STE 1004
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4969
Practice Address - Country:US
Practice Address - Phone:407-732-5753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-17
Last Update Date:2020-03-23
Deactivation Date:2018-11-26
Deactivation Code:
Reactivation Date:2018-12-10
Provider Licenses
StateLicense IDTaxonomies
NY340172363LF0000X
FL9453519363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily