Active NPI
Ellen Nadine Thomas, ARNP
- Nurse Practitioner
- Jacksonville, FL
National Provider Identifier
1487645578
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- ARNP1763212
- Practice address
- 6879 Southpoint Dr N
Jacksonville, FL 32216-6179 - Phone
- (904) 296-2441
- Fax
- (904) 821-3113
- NPI assigned
- Oct 29, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | ARNP1763212 | FL | Primary |
Addresses
Primary practice location
6879 Southpoint Dr N
Jacksonville, FL 32216-6179
Mailing address
PO Box 16568
Jacksonville, FL 32245-6568
Phone (904) 472-2300
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 305499300 | Medicaid | FL | |
| Y8429 | Other | FL | BLUECROSS/BLUESHIELD |
| 500011594 | Other | FL | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130544000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1318809600000",
"number": "1487645578",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 16568",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322456568",
"telephone_number": "904-472-2300",
"fax_number": "904-472-2330"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6879 SOUTHPOINT DR N",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322166179",
"telephone_number": "904-296-2441",
"fax_number": "904-821-3113"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THOMAS",
"first_name": "ELLEN",
"middle_name": "NADINE",
"name_prefix": "Ms.",
"credential": "ARNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-10-29",
"last_updated": "2011-10-17",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "FL",
"license": "ARNP1763212",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "305499300",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUECROSS/BLUESHIELD",
"identifier": "Y8429",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "500011594",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.