Provider Demographics
NPI:1710792791
Name:THOMAE, DESTANEE (APRN FNP)
Entity type:Individual
Prefix:
First Name:DESTANEE
Middle Name:
Last Name:THOMAE
Suffix:
Gender:F
Credentials:APRN FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1687 COUNTY ROAD 173
Mailing Address - Street 2:
Mailing Address - City:WINTERS
Mailing Address - State:TX
Mailing Address - Zip Code:79567-6609
Mailing Address - Country:US
Mailing Address - Phone:940-886-6628
Mailing Address - Fax:
Practice Address - Street 1:4438 S CLACK ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-3634
Practice Address - Country:US
Practice Address - Phone:325-704-4470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1190103363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner