Provider Demographics
NPI:1902311772
Name:THOMAS CARLENTINE, VICKI D (DNP, FNP-BC, APRN)
Entity Type:Individual
Prefix:DR
First Name:VICKI
Middle Name:D
Last Name:THOMAS CARLENTINE
Suffix:
Gender:F
Credentials:DNP, FNP-BC, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7003 N 89TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68122-5224
Mailing Address - Country:US
Mailing Address - Phone:402-690-0475
Mailing Address - Fax:
Practice Address - Street 1:9905 SAPP BROTHERS DR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68138-3951
Practice Address - Country:US
Practice Address - Phone:402-690-0475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2023363LF0000X, 363LX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE2023OtherAPRN STATE LICENSE