Provider Demographics
NPI:1700120698
Name:OSDER, THOMAS JOSEPH LEWIS (ARNP)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JOSEPH LEWIS
Last Name:OSDER
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4217 SW 64TH AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-3446
Mailing Address - Country:US
Mailing Address - Phone:954-432-1812
Mailing Address - Fax:954-430-3261
Practice Address - Street 1:4217 SW 64TH AVE STE 1
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-3446
Practice Address - Country:US
Practice Address - Phone:954-432-1812
Practice Address - Fax:954-430-3261
Is Sole Proprietor?:No
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9175576363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily