Provider Demographics
NPI:1225226889
Name:THORN, JAMIE MASHBURN (ARNP)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:MASHBURN
Last Name:THORN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2699
Mailing Address - Street 2:ATTN: SHMG/HPE
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32513-2699
Mailing Address - Country:US
Mailing Address - Phone:850-416-5050
Mailing Address - Fax:850-416-5022
Practice Address - Street 1:3754 HIGHWAY 90
Practice Address - Street 2:STE 220
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-1096
Practice Address - Country:US
Practice Address - Phone:850-416-5050
Practice Address - Fax:850-416-5022
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3277182363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ35497Medicare UPIN