Provider Demographics
NPI:1982620159
Name:TOMASIC, FLORENCE P
Entity Type:Individual
Prefix:
First Name:FLORENCE
Middle Name:P
Last Name:TOMASIC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 N MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76039-3632
Mailing Address - Country:US
Mailing Address - Phone:817-358-5800
Mailing Address - Fax:817-283-7686
Practice Address - Street 1:412 N MAIN
Practice Address - Street 2:SUITE 100
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76039
Practice Address - Country:US
Practice Address - Phone:817-358-5800
Practice Address - Fax:817-283-7686
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX534347 ANP GNP163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX088269803Medicaid
TX8D6059Medicare ID - Type Unspecified
TX088269803Medicaid