Provider Demographics
NPI:1306197942
Name:DENT-THOMAS, TAKESHIA MONIQUE (DNP, MSN, CCRN, NP-C)
Entity type:Individual
Prefix:DR
First Name:TAKESHIA
Middle Name:MONIQUE
Last Name:DENT-THOMAS
Suffix:
Gender:F
Credentials:DNP, MSN, CCRN, NP-C
Other - Prefix:DR
Other - First Name:TAKESHIA
Other - Middle Name:MONIQUE
Other - Last Name:DENT-THOMAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP, MSN, CCRN, NP-C
Mailing Address - Street 1:7070 AARON ARONOV DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35064-1830
Mailing Address - Country:US
Mailing Address - Phone:205-786-7600
Mailing Address - Fax:205-786-7602
Practice Address - Street 1:7070 AARON ARONOV DR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:AL
Practice Address - Zip Code:35064-1830
Practice Address - Country:US
Practice Address - Phone:205-786-7600
Practice Address - Fax:205-786-7602
Is Sole Proprietor?:No
Enumeration Date:2012-09-22
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-107825363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL186301Medicaid