Provider Demographics
NPI:1700160868
Name:THOMAS, PRISCILLA M (LPN)
Entity Type:Individual
Prefix:MS
First Name:PRISCILLA M
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22240 BOCA RANCHO DR APT B
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-4348
Mailing Address - Country:US
Mailing Address - Phone:561-908-4324
Mailing Address - Fax:
Practice Address - Street 1:22240 BOCA RANCHO DR APT B
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-4348
Practice Address - Country:US
Practice Address - Phone:561-908-4324
Practice Address - Fax:561-961-4663
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5167911164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse