Provider Demographics
NPI:1245477181
Name:THOMAS, RACHEL MCMAHAN (ARNP)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:MCMAHAN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:L
Other - Last Name:MCMAHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:480 W LOWDER ST
Mailing Address - Street 2:
Mailing Address - City:MACCLENNY
Mailing Address - State:FL
Mailing Address - Zip Code:32063-2664
Mailing Address - Country:US
Mailing Address - Phone:904-259-6291
Mailing Address - Fax:904-259-4761
Practice Address - Street 1:480 W LOWDER ST
Practice Address - Street 2:
Practice Address - City:MACCLENNY
Practice Address - State:FL
Practice Address - Zip Code:32063-2664
Practice Address - Country:US
Practice Address - Phone:904-259-6291
Practice Address - Fax:904-259-4761
Is Sole Proprietor?:No
Enumeration Date:2009-01-14
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3397642163WP0200X
FLARNP3397642363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008565000Medicaid
FLHD406ZOtherMEDICARE