Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | ME75642 | FL |
NPI | 1174577498 |
---|---|
Provider Name | Sheryl Olivia Thompson |
First Address | Tequesta, FL 33469-4709 |
Second Address | Tequesta, FL 33469-4709 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2006 |
Last Update Date | 27/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G60880 | (02) | FL |