Provider Demographics
NPI:1043748346
Name:THOMAS, JENNIFER DENISE (CRNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DENISE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:PERNELL
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6420 HILLCREST PARK CT
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-2688
Mailing Address - Country:US
Mailing Address - Phone:251-520-8700
Mailing Address - Fax:251-255-4251
Practice Address - Street 1:6420 HILLCREST PARK CT
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-2688
Practice Address - Country:US
Practice Address - Phone:251-520-8700
Practice Address - Fax:251-255-4251
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-31
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-123617363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology