Provider Demographics
NPI:1700634334
Name:THOMAS, VIBIN C (FNP-C, FNP-BC)
Entity Type:Individual
Prefix:
First Name:VIBIN
Middle Name:C
Last Name:THOMAS
Suffix:
Gender:M
Credentials:FNP-C, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3625 BRASELTON HWY STE 201
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-4695
Mailing Address - Country:US
Mailing Address - Phone:678-889-2326
Mailing Address - Fax:
Practice Address - Street 1:3625 BRASELTON HWY STE 201
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-4695
Practice Address - Country:US
Practice Address - Phone:678-889-2326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN306880363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily