Provider Demographics
NPI:1861160848
Name:ALLEN, THOMECIA A
Entity type:Individual
Prefix:
First Name:THOMECIA
Middle Name:A
Last Name:ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:THOMECIA
Other - Middle Name:
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5601 EDENFIELD RD APT 619
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32277-9427
Mailing Address - Country:US
Mailing Address - Phone:904-775-2316
Mailing Address - Fax:
Practice Address - Street 1:5601 EDENFIELD RD APT 619
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32277-9427
Practice Address - Country:US
Practice Address - Phone:904-775-2316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion