Provider Demographics
NPI:1376356154
Name:THOMPSON, TAWANNA SHERRIE
Entity type:Individual
Prefix:
First Name:TAWANNA
Middle Name:SHERRIE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4171 CIUDAD DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-7644
Mailing Address - Country:US
Mailing Address - Phone:850-377-4653
Mailing Address - Fax:
Practice Address - Street 1:4171 CIUDAD DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-7644
Practice Address - Country:US
Practice Address - Phone:850-377-4653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL25000018906251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health