Provider Demographics
NPI:1699112888
Name:THOMPSON, CLARABELL PHILISTINA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:CLARABELL
Middle Name:PHILISTINA
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 NE 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33138-6005
Mailing Address - Country:US
Mailing Address - Phone:305-754-8966
Mailing Address - Fax:
Practice Address - Street 1:6300 NE 2ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33138-6005
Practice Address - Country:US
Practice Address - Phone:305-754-8966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2514492363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health