Individual
THELISHA RENEE THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11802 SE 71ST AVENUE RD, BELLEVIEW, FL 34420-4672
(870) 714-5246
Mailing address
PO BOX 4975, OCALA, FL 34478-4975
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
693387401
—
FL
05
—
693387496
—
FL
Enumeration date
02/24/2011
Last updated
02/24/2011
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