Provider Demographics
NPI:1508104563
Name:THOMAS MASON, MERITA
Entity Type:Individual
Prefix:
First Name:MERITA
Middle Name:
Last Name:THOMAS MASON
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 1:1653 REGAL OAK DR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-6644
Mailing Address - Country:US
Mailing Address - Phone:407-350-4613
Mailing Address - Fax:
Practice Address - Street 1:1653 REGAL OAK DR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-6644
Practice Address - Country:US
Practice Address - Phone:407-350-4613
Practice Address - Fax:407-350-4613
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-26
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9272783163W00000X
FLARNP9272783363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse