Provider Demographics
NPI:1134614977
Name:FORD, THALIA CHRISTINA (ARNP)
Entity type:Individual
Prefix:
First Name:THALIA
Middle Name:CHRISTINA
Last Name:FORD
Suffix:
Gender:
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:668 MAITLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-6862
Mailing Address - Country:US
Mailing Address - Phone:407-675-3220
Mailing Address - Fax:407-675-3216
Practice Address - Street 1:668 MAITLAND AVE
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-6862
Practice Address - Country:US
Practice Address - Phone:407-675-3220
Practice Address - Fax:407-675-3216
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-25
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9306565363LF0000X
FL9306565363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily