Provider Demographics
NPI:1265265532
Name:THOMAS, NAKIEDRA NICOLE (MS, CF-SLP)
Entity type:Individual
Prefix:MRS
First Name:NAKIEDRA
Middle Name:NICOLE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13413 ENGLISH PEAK CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-5502
Mailing Address - Country:US
Mailing Address - Phone:205-928-2381
Mailing Address - Fax:
Practice Address - Street 1:9191 R G SKINNER PKWY UNIT 103
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-9656
Practice Address - Country:US
Practice Address - Phone:904-428-8302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ12064235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist