MR. JERMAINE DARIO OKANG THOMAS AGPCNP-BC NPI 1104471416

NPI Information

NPI: 1104471416
Provider Name: MR. JERMAINE DARIO OKANG THOMAS, AGPCNP-BC
Classification: Nurse Practitioner - 363LG0600X
Entity Type: Individual

Specialization: Gerontology

Organization: ELM TREE CLINIC LLC

PECOS Registration: Yes

Address:
801 MASSACHUSETTS AVE
2ND FL
BOSTON, MA
ZIP 02118
Phone: (617) 414-7399
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MR. Jermaine Dario Okang Thomas, AGPCNP-BC is a gerontology nurse practitioner in Boston, MA with 5 years of experience. MR. Jermaine Dario Okang Thomas, AGPCNP-BC NPI is 1104471416. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

801 MASSACHUSETTS AVE
2ND FL
BOSTON, MA
ZIP 02118-211
Phone: (617) 414-7399
Fax: (617) 414-4676

The NPI 1104471416 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 8/4/2019 and was last updated on 11/11/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	163WP2201X	Registered Nurse	Ambulatory Care	RN2320575	MASSACHUSETTS	No
2	363LA2100X	Nurse Practitioner	Acute Care	RN2320575	MASSACHUSETTS	No
3	363LG0600X	Nurse Practitioner	Gerontology	RN2320575	MASSACHUSETTS	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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