Provider Demographics
NPI:1306255690
Name:THOMAS, CHIQUITA MICHELLE (FNP)
Entity type:Individual
Prefix:
First Name:CHIQUITA
Middle Name:MICHELLE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 JULEE EMILYN DR
Mailing Address - Street 2:
Mailing Address - City:BONAIRE
Mailing Address - State:GA
Mailing Address - Zip Code:31005-4340
Mailing Address - Country:US
Mailing Address - Phone:478-319-9395
Mailing Address - Fax:
Practice Address - Street 1:1719 RUSSELL PKWY STE 700
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-5765
Practice Address - Country:US
Practice Address - Phone:478-328-7674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-12
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN201606363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily