Individual
PANCHAMI THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
410 S 11TH ST, LAKE WALES, FL 33853-4203
(863) 678-2200
(863) 419-4185
Mailing address
3835 MISTY LANDING DR, VALRICO, FL 33594-4802
(727) 424-8419
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
ARNP 9253922
FL
Other
Enumeration date
03/02/2017
Last updated
09/24/2019
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