Provider Demographics
NPI:1912900960
Name:THOMASON, TODD DANIEL (ARNP, NP-C)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:DANIEL
Last Name:THOMASON
Suffix:
Gender:M
Credentials:ARNP, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 N UNIVERSITY DR UNIT 841423
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33084-4106
Mailing Address - Country:US
Mailing Address - Phone:954-383-8836
Mailing Address - Fax:
Practice Address - Street 1:2350 N UNIVERSITY DR UNIT 841423
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33084-4106
Practice Address - Country:US
Practice Address - Phone:954-383-8836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2021-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9176643363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL303896300Medicaid
FLY006QOtherBLUE CROSS BLUE SHIELD
FLP37845Medicare UPIN