Provider Demographics
NPI:1740518430
Name:THOMAS, JACQUELINE (DO)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13800 TAMIAMI TRL N STE 112
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-6204
Mailing Address - Country:US
Mailing Address - Phone:239-500-7546
Mailing Address - Fax:239-294-8125
Practice Address - Street 1:3200 S UNIVERSITY DR
Practice Address - Street 2:SUITE 4345 ZIFF BUILDING
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-2018
Practice Address - Country:US
Practice Address - Phone:954-262-1647
Practice Address - Fax:954-262-3981
Is Sole Proprietor?:No
Enumeration Date:2009-11-18
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 9917207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology