Provider Demographics
NPI:1669719928
Name:THOMAS, DEANNA LYNN (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:LYNN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:DEANNA
Other - Middle Name:LYNN
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:1700 SPRING HILL AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36604-1416
Mailing Address - Country:US
Mailing Address - Phone:251-435-1200
Mailing Address - Fax:
Practice Address - Street 1:831 HILLCREST RD STE C
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-4075
Practice Address - Country:US
Practice Address - Phone:251-633-4949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-066789363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL825-15649OtherALABAMA BOARD OF MEDICAL EXAMINERS - QACSC
AL1-066789OtherSTATE OF ALABAMA NURSING/CRNP LICENSE
ALML3994882OtherCONTROLLED SUBSTANCE CERTIFICATE - DEA