Basic Information
| Provider Information | |||||||||
| NPI: | 1720313950 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THOMPSON | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | EDDINS | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | ARNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | EDDINS | ||||||||
| OtherFirstName: | ELIZABETH | ||||||||
| OtherMiddleName: | ASTRID | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 911 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | TRENTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326933239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3524632374 | ||||||||
| FaxNumber: | 3524632726 | ||||||||
| Practice Location | |||||||||
| Address1: | 630 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WILLISTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326961705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3525280587 | ||||||||
| FaxNumber: | 3525284834 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2009 | ||||||||
| LastUpdateDate: | 11/02/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | ARNP9251565 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | ARNP9251565 | 01 | FL | STATE LICENSE | OTHER | 62987 | 01 | FL | BCBSFL | OTHER | 001487600 | 05 | FL | MEDICAID |