Provider Demographics
NPI:1871516476
Name:SIPPRELL, THOMAS ANDERSON (DO)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:ANDERSON
Last Name:SIPPRELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 CASA ALOMA WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-2266
Mailing Address - Country:US
Mailing Address - Phone:407-677-6000
Mailing Address - Fax:407-677-6246
Practice Address - Street 1:2828 CASA ALOMA WAY
Practice Address - Street 2:100
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-2223
Practice Address - Country:US
Practice Address - Phone:407-677-6000
Practice Address - Fax:407-677-6246
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS4250207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL068199700Medicaid