Provider Demographics
NPI:1386354595
Name:THOMPSON, KAITLYN (FNP-C)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:
Credentials:FNP-C
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:
Other - Last Name:SAMBLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-434-9562
Mailing Address - Fax:
Practice Address - Street 1:7125 MURRELL RD STE D
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-7999
Practice Address - Country:US
Practice Address - Phone:321-434-9562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-29
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11036627363L00000X
FLRN9477178163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLUS013OtherMEDICARE HF