Provider Demographics
NPI:1396977419
Name:THOMAS, JANALEA KRISTIN (PA-C)
Entity type:Individual
Prefix:
First Name:JANALEA
Middle Name:KRISTIN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PA-C
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 166321
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33116-6321
Mailing Address - Country:US
Mailing Address - Phone:239-949-1777
Mailing Address - Fax:239-498-3777
Practice Address - Street 1:9776 BONITA BEACH RD SE
Practice Address - Street 2:SUITE 102
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-4773
Practice Address - Country:US
Practice Address - Phone:239-949-1777
Practice Address - Fax:239-498-3777
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-24
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA3342363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00001Medicare PIN