Provider Demographics
NPI:1679566558
Name:MOHAN, THOMAS R (ARNP)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:R
Last Name:MOHAN
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 SW 20TH PL STE 100
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-7881
Mailing Address - Country:US
Mailing Address - Phone:352-237-1212
Mailing Address - Fax:352-237-0066
Practice Address - Street 1:1920 SW 20TH PL STE 100
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-7881
Practice Address - Country:US
Practice Address - Phone:352-237-1212
Practice Address - Fax:352-237-0066
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3386112363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE6942SOtherMEDICARE PTAN OCALA W
FL304791100Medicaid
FLE6942YOtherMEDICARE ID PREVIOUS
FLE6942YOtherMEDICARE ID PREVIOUS