Provider Demographics
NPI:1487873998
Name:KIERNAN, THOMAS E (ARNP)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:E
Last Name:KIERNAN
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7955 66TH ST STE D
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-2161
Mailing Address - Country:US
Mailing Address - Phone:727-541-3362
Mailing Address - Fax:727-544-4015
Practice Address - Street 1:7955 66TH ST STE D
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-2161
Practice Address - Country:US
Practice Address - Phone:727-541-3362
Practice Address - Fax:727-544-4015
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP830052363LA2200X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Not Answered363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY3765AMedicare ID - Type Unspecified