Provider Demographics
NPI:1699420109
Name:THOMAS, JESSICA LANICE
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LANICE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 PECAN RUN
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34472-1924
Mailing Address - Country:US
Mailing Address - Phone:352-414-9229
Mailing Address - Fax:
Practice Address - Street 1:30 PECAN RUN
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34472-1924
Practice Address - Country:US
Practice Address - Phone:352-414-9229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities