Provider Demographics
NPI:1265975304
Name:THOMPSON, JANICE (LPN,BSN)
Entity type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LPN,BSN
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:
Other - Last Name:CLARKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN, BSN
Mailing Address - Street 1:8327 NORTHGATE DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-8614
Mailing Address - Country:US
Mailing Address - Phone:407-290-9606
Mailing Address - Fax:
Practice Address - Street 1:8327 NORTHGATE DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-8614
Practice Address - Country:US
Practice Address - Phone:407-290-9606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN1149581164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse