Provider Demographics
NPI:1013019108
Name:TOMAJKO, TABATHA ALMA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:TABATHA
Middle Name:ALMA
Last Name:TOMAJKO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1995 E COALTON RD
Mailing Address - Street 2:APT 76-101
Mailing Address - City:SUPERIOR
Mailing Address - State:CO
Mailing Address - Zip Code:80027-4419
Mailing Address - Country:US
Mailing Address - Phone:203-940-1367
Mailing Address - Fax:
Practice Address - Street 1:300 EXEMPLA CIRCLE, SUITE 360
Practice Address - Street 2:BLUESTONE ADVANCED SURGICAL CARE
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026
Practice Address - Country:US
Practice Address - Phone:303-689-6560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2898363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTQ66726Medicare UPIN