Organization
VA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS RICHARD OBRIEN LPN (LPN)
(352) 376-1611
Entity
Organization
Contact information
Practice address
1601 S.W. ARCHER ROAD, GAINESVILLE, FL 32608-1197
(352) 376-1611
Mailing address
1601 S.W. ARCHER ROAD, GAINESVILLE, FL 32608-1197
(352) 376-1611
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN5148178
FL
Other
Enumeration date
10/04/2017
Last updated
10/04/2017
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