Basic Information
| Provider Information | |||||||||
| NPI: | 1609326537 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | EDDY | ||||||||
| MiddleName: | SHANE | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1154 EARLYLIGHT CT | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043057492 | ||||||||
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| Practice Location | |||||||||
| Address1: | 300 HEALTH PARK BLVD STE 4000 | ||||||||
| Address2: | |||||||||
| City: | ST AUGUSTINE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320863704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9048248666 | ||||||||
| FaxNumber: | 9048248933 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2016 | ||||||||
| LastUpdateDate: | 10/04/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | ARNP9247428 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.