Provider Demographics
NPI:1174969588
Name:THOMAS, ANNETTE ANGELA
Entity type:Individual
Prefix:MS
First Name:ANNETTE
Middle Name:ANGELA
Last Name:THOMAS
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 1:18520 SATSUMA AVE
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-7520
Mailing Address - Country:US
Mailing Address - Phone:941-625-8264
Mailing Address - Fax:941-625-8264
Practice Address - Street 1:18520 SATSUMA AVE
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-7520
Practice Address - Country:US
Practice Address - Phone:941-625-8264
Practice Address - Fax:941-625-8264
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-13
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6906610311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home